bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Body Mass Index With Major Cardiovascular Events and With Mortality After Percutaneous Coronary Intervention
Authors: Park Duk-Woo , Kim Young-Hak , Yun Sung-Cheol , Ahn Jung-Min , Lee Jong-Young , Kim Won-Jang , Kang Soo-Jin , Lee Seung-Whan , Lee Cheol Whan , Park Seong-Wook , Park Seung-Jung
Published: March 2013

Background—

Conflicting data exist regarding the relation between body mass index (BMI) and cardiovascular events and mortality after percutaneous coronary intervention.

Methods and Results—

We performed pooled analyses to evaluate the association between BMI (weight in kilograms divided by the square of the height in meters) and the risks of major cardiovascular events (defined as death from cardiovascular causes, nonfatal myocardial infarction, stent thrombosis, or stroke) and death among 23 181 patients from 11 prospective percutaneous coronary intervention studies. Overall, mean (±SD) BMI was 24.9±3.0. During follow-up (median, 2.1 years), 2381 patients had a major cardiovascular event, and 1004 patients died. After adjusting covariates, there was an inverse relationship between BMI and adverse outcomes. With a BMI of 22.5 to 24.9 as the reference category, the risk of major cardiovascular events was elevated among patients with a lower BMI (by a factor of 1.52 for a BMI <18.5; 1.05 for a BMI of 18.5–19.9; 1.03 for a BMI of 20.0–22.4); by contrast, the risk declined among patients with a higher BMI (by a factor of 0.97 for a BMI of 25.0–27.4; 0.97 for a BMI of 27.5–29.9; and 0.78 for a BMI of ≥30.0). In general, the hazard ratios for deaths were similar.

Conclusions—

Among patients undergoing percutaneous coronary intervention, a low BMI was associated with increased risks of major cardiovascular events and death. However, there were no excess risks of these events associated with a high BMI.
Hemorrhagic and Ischemic Outcomes After Bivalirudin Versus Unfractionated Heparin During Carotid Artery Stenting
Authors: Wayangankar Siddharth A. , Abu-Fadel Mazen S. , Aronow Herbert D. , Kennedy Kevin F. , Gupta Raghav , Yeh Robert W. , Gray William A. , Rosenfield Kenneth , Hennebry Thomas A.
Published: March 2013

Background—

The direct thrombin inhibitor, bivalirudin, is associated with similar efficacy and superior safety in patients undergoing percutaneous coronary intervention. However, the role of direct thrombin inhibitors in carotid artery stenting is not well defined. The objective of this study was to compare the safety and effectiveness of bivalirudin and unfractionated heparin (UFH) for carotid artery stenting. We hypothesized that bivalirudin would be associated with less in-hospital postprocedure bleeding than UFH but similar rates of in-hospital and 30-day ischemic outcomes.

Methods and Results—

We compared the incidence of in-hospital hemorrhagic and in-hospital/30-day ischemic outcomes among patients in the CARE Registry who underwent carotid artery stenting between May 2005 and March 2012 using bivalirudin or UFH. Propensity score matching was used to obtain a balanced cohort of 3555 patients in each treatment group. Patients treated with bivalirudin had a significantly lower incidence of bleeding or hematoma requiring red blood cell transfusions (0.9% versus 1.5%; odds ratio, 0.57 [0.36–0.89];
P
=0.01) when compared with UFH-treated patients. The incidence of in-hospital and 30-day ischemic outcomes, including death, myocardial infarction, stroke, transient ischemic attack, and the composite outcome, death/myocardial infarction/stroke, did not differ significantly between groups.

Conclusions—

Bivalirudin was associated with lower rates of hemorrhagic outcomes compared with UFH during the index hospitalization for carotid artery stenting. In-hospital and 30-day ischemic events were similar between the 2 groups. Randomized comparisons of these agents are needed to confirm these findings.
Efficacy of Coupling Inhibitory and Facilitatory Repetitive Transcranial Magnetic Stimulation to Enhance Motor Recovery in Hemiplegic Stroke Patients
Authors: Sung Wen-Hsu , Wang Chih-Pin , Chou Chen-Liang , Chen Yi-Cheng , Chang Yue-Cune , Tsai Po-Yi
Published: March 2013

Background and Purpose—

Although there has been extensive research on the effectiveness of repetitive transcranial magnetic stimulation (rTMS) to improve patients’ motor performance after experiencing chronic stroke, explicit findings on the coupling of different rTMS protocols are meager. We designed this sham-controlled randomized study to investigate the potential for a consecutive suppressive-facilitatory TMS protocol to improve motor outcomes after chronic stroke.

Methods—

Fifty-four chronic hemiplegic stroke patients were allocated across 4 groups to undergo 20 daily sessions of (1) 1 Hz rTMS over the contralesional primary motor cortex (M1) and then intermittent theta burst stimulation over the ipsilesional M1 (group A); (2) contralesional sham stimulation and then ipsilesional real intermittent theta burst stimulation (group B); (3) contralesional real 1 Hz rTMS and then ipsilesional sham stimulation (group C); or (4) bilateral sham-control procedures (group D). We tested cortical excitability and motor activity assessments at the baseline, postpriming rTMS, and postconsequent rTMS periods.

Results—

At post, group A showed greater muscle strength, Fugl-Meyer Assessment (FMA), Wolf Motor Function test, and reaction time improvement in comparison with group B (
P
<0.001≈0.003) and group C (
P
=0.001≈0.003). Correlation analyses in group A revealed a close relation between contralesional map area decrement and Wolf Motor Function test gain (
P
=0.005;
r
=−0.75), and also revealed ipsilesional map area increment and reaction time decrement (
P
=0.02;
r
=−0.87). We detected no such relations in the other 3 groups.

Conclusions—

Our clinical trials established an extended timeframe during which conditioning could be safely continued and produced more favorable outcomes in facilitating motor performance and ameliorating interhemispheric imbalance than those obtained from single-course rTMS modulation alone.
Observations on Hippodonta (Bacillariophyceae) in selected ancient lakes
Authors: PAVLOV ALEKSANDAR , LEVKOV ZLATKO , WILLIAMS DAVID M. , EDLUND MARK B.
Published: March 2013

This study provides an evaluation of the diversity and distribution of taxa belonging to the genus Hippodonta (Bacillariophyceae) in selected ancient lakes from different geographical regions of the world. The lakes considered are: Lakes Ohrid, Prespa and Dojran fromMacedonia,Lake Tanganyika,Tanzania,Lake Turkana,KenyaandLakeBaikal, Russia. In total, there are 34 Hippodonta taxa. Of these, 21 are described as new, 20 species and one variety. The primary morphological features of each taxon are provided and formal descriptions are given for all new taxa. The distinctive characters distinguishing similar taxa are noted. The genus is most diverse inLakeBaikalwith 13 taxa, of which four are described as new species (Hippodonta acuta, H. certa, H. communis and H. pulchra).Lake Tanganyika has six taxa, all of which are described as new (H. angustata, H. avittatiformis, H. cocquytiae, H. conspicua, H. crassa and H. radiata). Lake Turkanahas only one taxon, also described as new (H. minuta). In the Macedonian old tectonic lakes, seven taxa were found in LakeOhrid, with five described as new (H. abunda, H. humboldtiana, H. latelanceolata, H. naviculiformis and H. subrostrata), five taxa were found in Lake Prespa, all of which are described as new (H. affinis, H. costulatiformis var. densistriata, H. exigua, H. media and H. rostratoides), and three known taxa were found inLakeDojran.
“Not This One”
Authors: Tufekci Zeynep
Published: March 2013

The emergent new media ecology which integrates participatory media into the structure of global information flows has fundamentally affected the means of production and distribution of attention, a key resource for social movements. In social movement scholarship, attention itself is rarely examined directly; rather, it is encountered in the study of means of delivering attention such as mass media or celebrities. This conflation of the resource, attention, and the pathways to acquire it, such as mass media, was less of an analytic problem when mass media enjoyed a near monopoly on public attention. However, the paths connecting movement actors and public attention are increasingly multiplex and include civic and social media. In this article, I examine the concept of attention as a distinct analytic category, reevaluate social movement scholarship in light of weakening of the monopoly on public attention, and introduce and examine a novel dynamic brought about by emergent attention economy: networked microcelebrity activism. I examine this novel dynamic through case studies and raise questions for future exploration.
Integration Tutorials and Seminars: A Creative Learning Approach for Occupational Therapy Curricula
Authors: Smits Emely , Ferguson Janice
Published: March 2013

This paper, the first of two companion papers, describes a creative learning approach. Integration Tutorials and Seminars were developed to address concerns of regional fieldwork-education coordinators and preceptors about the ability of third-year student occupational therapists to integrate and apply academic and theoretical knowledge during fieldwork. This ability can be gained through experiential learning in the academic setting and is essential for the effective transfer of academic learning into the students' fieldwork-education experiences (Dale, 1994; Fidler, 1996; McCaugherty, 1991; Neistadt, 1996).

The Modified Learning Model of Svinicki and Dixon (1987) was used as a template for an academic course fostering experiential learning. An important secondary goal was to nurture student self-directedness in learning using the philosophy of the Staged Self-Directed Learning Model (Grow, 1991). Case studies were used as a vehicle for engaging and challenging the students.

The philosophy, guidelines and process of the Integration Tutorials and Seminars are presented and have the potential to be adapted for occupational therapy curricula around the globe.
Comparaison des caractéristiques comportementales de l'état d'alerte spontané et de l'état libéré chez le nouveau-né à terme
Authors: Clément Annie , Gosselin Julie
Published: March 2013

Les ergothérapeutes évaluent de plus en plus tôt les capacités des nourrissons. La vigilance très variable de ces derniers influence inévitablement l'expression de leurs comportements. Pour contrer l'effet de cette instabilité, Grenier (1985) propose l'état libéré qui permet d'optimiser la qualité d'attention du nourrisson. Le but de l'étude était d'identifier les comportements distinguant cet état libéré de l'état d'alerte (état 4) décrit par Brazelton (1973). Certains paramètres définis dans le modèle de l'organisation synactive du développement de Als (1982) ont été retenus pour répertorier les comportements des nourrissons dans les deux états de vigilance. L'âge moyen au moment de l'observation était de 62 heures. La durée de cette observation des comportements était de 5 minutes. Parmi les 54 nouveau-nés à terme évalués, 21 ont pu être observés dans les 2 états de vigilance à l'étude; 33 ont été évalués dans un seul état. Les résultats confirment la stabilité supérieure de l'état libéré. Les comportements de stress, d'auto-régulation et les besoins de régulation externe sont moins fréquents dans cet état; ces différences sont statistiquement significatives (p<0,05). La motricité dirigée est plus fréquente en état libéré (p<0,001). L'utilisation de l'état libéré est proposée pour l'exploration des capacités précoces du nourrisson.
Validation d'un instrument de mesure pour évaluer l'accès à l'ordinateur chez les personnes ayant une déficience physique
Authors: Dumont Claire , Dionne Clermont
Published: March 2013

Le but de cette étude est de créer un instrument de mesure du rendement dans l'utilisation de l'ordinateur pour les personnes ayant une déficience physique. Les objectifs sont de s'assurer de la validité de contenu et de la cohérence interne de l'instrument, ainsi que de tester la fidélité de chaque tâche du test. La première étape a été de déterminer les actions qui doivent être accomplies avec le clavier et la souris pour réaliser toutes les fonctions de l'ordinateur. À partir de ces actions, quinze tâches ont été élaborées et standardisées pour former le test. En deuxième étape, le test a été administré à deux reprises à 19 personnes sans incapacité et 17 personnes avec incapacités afin d'en déterminer la fidélité. Plusieurs tâches démontrent une bonne fidélité et l'instrument possède une bonne cohérence interne. Cet outil peut contribuer à améliorer la qualité des interventions ergothérapiques visant l'accès à l'ordinateur.
Impact d'un programme multi-stratégique de groupe sur le fonctionnement dans les activités de la vie domestique de personnes âgées présentant des déficits cognitifs légers
Authors: Viscogliosi Chantal , Desrosiers Johanne , Gauthier Pierre , Beauchemin Richard
Published: March 2013

Objectif: Cette étude vise à évaluer l'impact, sur le fonctionnement dans les activités de la vie domestique (A.V.D.), d'un programme d'activités de groupe élaboré spécifiquement pour des personnes présentant des déficits cognitifs légers vivant à domicile et fréquentant un centre de jour.

Méthode: Un dispositif à sujet unique de type AB a été utilisé auprès de onze personnes assignées aléatoirement au groupe expérimental (n=7) et au groupe témoin (n=4). Leur fonctionnement cognitif se situe entre le 5e et le 25e centile au Modified-Mini-Mental State Examination (3MS) correspondant au stade 3 de l'échelle de Reisberg. Le programme multi-stratégique, d'une durée de 16 semaines, offre deux rencontres hebdomadaires d'une heure trente chacune. Ce programme utilise des exercices physiques, des techniques psychomusicales, des jeux cognitifs et la pratique de tâches reliées aux A.V.D. Le fonctionnement dans les A.V.D. des sujets a été mesuré à leur domicile avec le Assessment of Motor and Process Skills (A.M.P.S.) à six reprises, avant, pendant et après le programme.

Résultats: Les données de chaque sujet ont été traitées par analyse visuelle graphique. À la suite de l'application du programme, il y a davantage de participants que de sujets témoins qui ont amélioré leur fonctionnement au niveau des A.V.D.

Conclusion: Les résultats de cette étude laissent supposer qu'il serait possible d'utiliser des stratégies d'adaptation à des stades précoces de déficits cognitifs.
Clinical Description of Children with Developmental Coordination Disorder
Authors: Miller Linda T. , Missiuna Cheryl A. , Macnab Jennifer J. , Malloy-Miller Theresa , Polatajko Helene J.
Published: March 2013

Occupational therapists working within School Health Support Services are receiving increasing numbers of referrals, relative to past rates, for children who are experiencing motor problems and may have developmental coordination disorder. Based upon clinical experience, therapists indicate that these children are typically referred in the early school years and that most have handwriting difficulties; to date, however, there has been little empirical evidence to support these observations. In this paper, descriptive information is presented for 556 children who may be presumed to have developmental coordination disorder and who had been referred to school-based health services in two centres. Typical reasons for referral, co-morbidity information, and assessment practices are presented. Findings confirmed the presence of many occupational performance issues in this population, including handwriting difficulties, and challenge therapists to broaden the current scope of school health assessment and intervention practices.
Career Choices: A Comparison of Two Occupational Therapy Practice Groups
Authors: Wilkins Seanne , Rosenthal Carolyn
Published: March 2013

The increasing number of elderly people in the population and their greater use of the health care system require an increasing number of health care providers to work with older adults. A shortage of health care professionals to provide this care, as well as a reluctance to provide such care have been reported in the literature. The purpose of this qualitative study was to investigate how occupational therapists decide to work with older adults. Using a comparative approach, 40 occupational therapists were interviewed, 20 working in gerontology and 20 working in paediatrics. The findings indicate that social characteristics and experiences of the individual, as well as the context of work are important influences for practice choice decisions. Mapping of career paths led to the development of a typology to further describe the different influences involved in the career choices of these occupational therapists. Recommendations related to education and practice provide practical means by which to implement change.
Occupational Therapy Practice Patterns with Older Swedish Persons at Home
Authors: Lilja Margareta , Borell Lena
Published: March 2013

This paper explores and describes occupational therapy practice patterns during two periods for 89 elderly persons living at home. Occupational therapists working in one social welfare district in Stockholm, Sweden documented and reported every occupational therapy intervention provided. The results revealed that the elderly persons who received occupational therapy services during an extended period had an age span of 30 years, with a mean age over 80 years. They had several medical problems and were living in different types of settings.

Occupational therapists provided a wide range of interventions, most frequently categorised as treatment, especially related to leisure activities. Irrespective of level of care, the median of interventions per person increased or was the same over time, and 72% of the elderly persons remained at the same level of care. Enabling occupation for elderly disabled person living in their home involves constantly adjusting to the current situation since the clients' capacities, goals and environment change over time. Therefore, occupational therapists need to have a client-centred approach working in home health community services.
Enabling Occupation: The Importance of an Affirming Environment
Authors: Rebeiro Karen L.
Published: March 2013

Occupational therapists have become increasingly concerned with factors beyond the individual which impact occupational performance. Several recent models propose that the environment is a significant influence on occupational performance and upon its meaningfulness. An in-depth, qualitative study was conducted which explored the meaning of occupational engagement for eight women with mental illness (Rebeiro & Cook, 1999). This study yielded several important insights about the environment, which have recently been replicated by Legault and Rebeiro (2001) and Rebeiro, Day, Semeniuk, O'Brien, and Wilson (In Press). Participants suggested that environments that provide opportunity, and not prescription are more conducive to fostering occupational performance. Participants further suggested that an environment that provides Affirmation of the individual as a person of worth, a place to belong, and a place to be supported, enables occupational performance over time. A series of research studies indicated that the social environment is an important consideration in planning therapeutic interventions which aim to enable occupation. Implications for occupational therapy practice, education and research are offered
The Clinical Utility of the Test of Playfulness
Authors: Cameron Debra , Leslie Michele , Teplicky Rachel , Pollock Nancy , Stewart Debra , Toal Coleen , Gaik Sandy
Published: March 2013

Occupational therapists' increased focus on play as an occupation has created a need for play assessments that reflect this perspective. This study examined the clinical utility of the recently developed Test of Playfulness (ToP) (Bundy, 1997a) when used with children with disabilities. Changes in the participant's views of the child, the therapy goals, and the intervention plans after using the ToP were explored. Fourteen paediatric occupational therapists assessed children using the ToP, completed a clinical utility questionnaire and attended a focus group. Participants found the ToP easy to administer and score, however some found interpreting the results difficult. The ToP highlights the interactions between the child, activity and environment, and illustrates the child's strengths in his/her role as a player. The results suggest the ToP is a useful tool for assessing playfulness. Additional education and research is needed to provide further direction for intervention and incorporation into practice.
Driving and Dementia: A Review of the Literature
Authors: Lloyd Susan , Cormack Carla Noelle , Blais Kari , Messeri Gila , McCallum Mary Anne , Spicer Kerrie , Morgan Sarah
Published: March 2013

In North American society driving is closely linked with independence. Unfortunately, the freedom to operate a motor vehicle may be lost when an individual develops a specific medical diagnosis. The complex issue of dementia and driving safety is frequently encountered by health care professionals. Physicians are required, by law, to report any medical diagnosis such as dementia, that may affect driving safety. Physicians often refer to occupational therapists to assist them in determining if an individual's impairment significantly impacts driving safety. Unfortunately many health care professionals are not using reliable, valid and sensitive tests to determine the point at which an individual with dementia will become an unsafe driver. Through a review of the literature, the authors explore the effects of normal aging and cognitive impairment on driving safety. Specific assessment tools used to assess driving ability are examined and the role of health professionals in driver assessment is discussed. Some suggestions to improve the overall approach to evaluating driving safety are offered in the conclusion.
Processus de transformation chez un groupe de personnes cadiaques suivies en ergothérapie pour une modification de leur équilibre du fonctionnement occupationnel
Authors: Dubouloz Claire-Jehanne , Chevrier Jacques , Savoie-Zajc Lorraine
Published: March 2013

L'apprentissage transformateur est un processus d'évolution qui permet le changement personnel profond chez les clients suivis en ergothérapie. Ce processus est provoqué par un déclencheur comme la maladie et découle d'une réflexion critique sur les valeurs, croyances, sentiments et connaissances personnels associés à l'objet de changement (Mezirow, 1991). Dans le cadre d'un objectif de modification de l'équilibre du fonctionnement occupationnel (EFO), neufs informateurs ont été interviewés sur une période de 6 mois chacun afin d'explorer leur processus de changement. Huit conceptions reliées à l'objectif de modification de l'EFO ont émergé à l'aide d'un processus d'analyse inductive des données (Glaser et Strauss, 1967). La conception du travail a été interprétée par les auteurs comme celle qui avait subi le plus de transformation de sens chez les informateurs. Deux autres conceptions, 1) la définition de soi et 2) la conception de la santé ont émergé comme nouvelles valeurs essentielles à la modification de l'EFO. Le processus de transformation relié à ces huit conceptions présente une structure et une séquence particulière. Les résultats mettent en lumière le rôle primordial de la réflexion critique chez des clients suivis en ergothérapie et soulignent l'importance de la déconstruction de valeurs et croyances habituelles pouvant provoquer un frein au changement. De plus, la construction de nouvelles valeurs et croyances est un moteur du changement en ergothérapie.
Intrinsicality: Reconsidering Spirituality, Meaning(s) and Mandates
Authors: Hammell Karen Whalley
Published: March 2013

Canadian occupational therapists have placed spirituality as the central core of their theoretical Model, depicting inner and outer selves that contradict simultaneous declarations concerning the integration of mind/body/spirit. Even the word spirituality has discrepant meanings and failure to articulate one chosen meaning leads to ambiguity. This paper argues that occupational therapists must agree upon a single definition of spirituality that is congruent with our professional mandate and philosophical perspective; and that prevention of misunderstandings between and amongst clients and other health care professionals demands recourse to our own terminology. It is proposed that intrinsicality be employed to articulate the personal philosophy of meaning with which we interpret our lives. Influenced by environmental context and in homeostatic relationship with the body and mind, intrinsicality constitutes the essence of the self and informs occupational choices based upon personal values and priorities. Acknowledgement of intrinsicality respects the uniqueness of individuals' meanings.
The History of Occupational Therapy Assistants in Canada: A Comparison with the United States
Authors: Salvatori Penny
Published: March 2013

In the middle of the twentieth century, the role of occupational therapy assistant was introduced in North America. Although the role, utilization and training of assistant personnel have raised much controversy and debate within the profession, Canada and the United States have taken very different paths in terms of dealing with these issues. This paper focuses on the history of occupational therapy assistants in Canada, using the experience in the United States for comparison purposes. The occupational therapy literature and official documents of the professional associations are used to present a chronology of major historical events in both countries. Similarities and differences emerge in relation to historical roots; training model and standards of education; certification, regulation, and standards of practice; career laddering and career mobility; and professional affiliation. The paper concludes with a summary of issues which require further exploration, debate and resolution if the profession is to move forward in Canada.
Spirituality Unplugged: A Review of Commonalities and Contentions, and a Resolution
Authors: Unruh Anita M. , Versnel Joan , Kerr Natasha
Published: March 2013

Spirituality is an important and essential component of occupational therapy, but recent publications in occupational therapy literature also raise questions about the adequacy of the Canadian Association of Occupational Therapists' definition of spirituality and the relationship of spirituality to occupational performance. Reexamination of spirituality and occupation is needed to better understand the role of occupational therapists with respect to spirituality. In this paper, the authors examine the common themes that are inherent in definitions of spirituality from diverse professional perspectives. The commonalities and contentions inherent in these definitions are then contrasted with the perspectives of occupational therapists. This discussion is followed by a challenge for re-examination of spirituality in the Canadian Model of Occupational Performance, and an argument that occupational identity rather than spirituality should have a central position. The implications of spirituality and occupational identity for evidence-based occupational therapy are considered.
Théories qui émergent du quotidien de la pratique communautaire de l'ergothérapie
Authors: Hébert Michéle , Maheux Brigitte , Potvin Louise
Published: March 2013

Les ergothérapeutes ayant une pratique communautaire ont adapté leurs savoirs aux particularités et aux attentes de leurs milieux. Ce faisant, par leur réflexion dans l'agir et sur l'agir professionnel, ils ont développé des savoirs spécifiques bien ancrés dans la réalité de la pratique. Une enquête sur l'ergothérapie dans les Centres locaux de services communautaires du Québec (CLSC) a révélé trois théories que les ergothérapeutes ont développées au quotidien de leur pratique. La première se rapporte principalement au mode de traitement des demandes de services alors que les deux autres réfèrent plus directement au rôle de l'ergothérapeute au sein de l'équipe d'intervention. Elles reflètent les pressions organisationnelles que vivent les ergothérapeutes qui travaillent en milieux communautaires et les stratégies qu'ils ont élaborées pour y faire face. Cet article présente d'abord brièvement les résultats de l'enquête, les théories qui en émergent et les éléments de congruence avec les théories de référence en ergothérapie. Quelques pistes de réflexion sont proposées pour harmoniser les contraintes actuelles vécues dans le réseau communautaire des services de santé et les valeurs professionnelles en ergothérapie.
Clinical Utility of the Canadian Occupational Performance Measure - Swedish Version
Authors: Wressle Ewa , Marcusson Jan , Henriksson Chris
Published: March 2013

The Canadian Occupational Performance Measure (COPM) is an individualised outcome measure intended to detect change in a client's perception of occupational performance over time. The aim of this study was to test the clinical utility of the Swedish version of the COPM. Data was collected from 27 occupational therapists in six focus groups.

Emerging themes included goal-setting, preparations, limitations, interactions with clients, and impact on practice. The results indicated that the COPM is helpful in the goal-setting process and in planning treatment interventions. Therapists need knowledge about the theoretical foundation of the instrument and a personal interview technique. Problems were found using the instrument with clients who had poor insight or in acute settings. The COPM facilitated feedback on improvement over time. In summary, the COPM ensures a client-centred approach, facilitates communication within the rehabilitation team, and encourages therapists in their professional role.
Individualized Outcome Measures: A Review of the Literature
Authors: Donnelly Catherine , Carswell Anne
Published: March 2013

The client-centred nature of occupational therapy acknowledges the individual as the central element of treatment. This philosophy, however, challenges the therapist to choose an outcome measure that is capable of reflecting this individualized perspective. Recent papers published in the rehabilitation literature have reported on the increased responsiveness of such measures over traditional self-report questionnaires. Although the need for a comprehensive review of individualized outcome measures has been identified in the literature, none exists to date.

The purpose of this paper is to review six individualized outcome measures that have been identified in the rehabilitation and psychology literature. The measures include: the Canadian Occupational Performance Measure, the Assessment of Motor and Process Skills, McMaster (MAC) Toronto Arthritis, Goal Attainment Scaling, Target Complaints and the Patient Specific Functional Scale.

The reliability, validity, responsiveness and clinical utility of each outcome measure was examined and critiqued. Each tool, to a varying degree, met the description of a standardized, client-centred outcome measure.
Measuring the Impact of Parkinson's Disease: An Occupational Therapy Perspective
Authors: Gaudet Paula
Published: March 2013

Parkinson's disease is a common neurodegenerative disorder, affecting over 100,000 Canadians. With advances in medical and surgical treatments, clients are living longer and fuller lives. However, as the disease progresses those with Parkinson's continue to face a variety of deficits in their occupational performance. Although this is the domain of occupational therapists, very little is described in the occupational therapy literature related to Parkinson's. This article addresses this void by describing these deficits and current measurement tools that can be used to evaluate the impact on people living with Parkinson's disease. Although several tools are cited, three tools are recommended for an occupational therapy evaluation of individuals with Parkinson's disease: the Canadian Occupational Performance Measure, the Unified Parkinson's Disease Rating Scale and the Parkinson's Disease Questionnaire.
The Impact of Reimbursement Systems on Occupational Therapy Practice in Canada and the United States of America
Authors: Jongbloed Lyn , Wendland Toby
Published: March 2013

Different funding and cost-control mechanisms in Canada and the United States of America (USA) have a powerful influence on occupational therapy practice in each country. Canada's public health insurance system emphasizes access to health care services based on medical need. Costs are controlled at the provincial government level by limiting the capacity of facilities and personnel. Occupational therapists in publicly-funded settings have considerable professional autonomy to use occupational therapy theoretical models and to be client-centred. The measurement of outcomes is not always required and the interventions of individual occupational therapists are infrequently scrutinized. The USA has no universal, publicly-funded, comprehensive health insurance. Health care policies are driven by financial priorities and cost control occurs at the service delivery level. Insurance companies define the scope of occupational therapy practice by identifying what services they will pay for and they scrutinize occupational therapy interventions. The emphasis on effectiveness and efficiency leads to critical examination of interventions by therapists. Canadian occupational therapists can learn much from their colleagues in the USA in this area.
Reflections On… Occupational Therapy and Assertive Community Treatment
Authors: Krupa Terry , Radloff-Gabriel Debbie , Whippey Elizabeth , Kirsh Bonnie
Published: March 2013

Occupational therapists can play a valuable role on Assertive Community Treatment Teams (ACT). ACT is a widely disseminated, community based model of service delivery for individuals with severe psychiatric disabilities and high support needs. This paper discusses the generalist and specialist functions of occupational therapists within ACT. It is argued that occupational therapy addresses the occupational health and well being of ACT clients by intervening at three levels: the individual, the program and the community. This occupational focus is consistent with the ACT goal of enhancing community adjustment and quality of life. The paper concludes with a discussion of the opportunities and the constraints that face occupational therapists working within ACT.
Évaluation d'un programme de valorisation de fauteuils roulants
Authors: Vincent Claude , Routhier François , Guérette Chantal
Published: March 2013

Description générale. En 1998, 11,8% des Québécois de plus de 15 ans présentaient des problèmes de mobilité et 2,3% de cette clientèle exprimaient des besoins non comblés. La même année, la Régie de l'assurance-maladie du Québec a attribué plus de 4500 fauteuils roulants et en a réparé plus de 30000, pour une facture excédent 20 M$. Ces chiffres justifient amplement qu'on s'attarde aux politiques publiques entourant l'attribution des fauteuils roulants. Á cet effet, la valorisation (recyclage) des fauteuils roulants est souvent envisagée comme une solution pour combler des besoins de mobilité à moindre coût. Cet article présente une évaluation d'un programme de valorisation. Méthodologie. Trois groupes ont été recrutés: le personnel du programme d'aides techniques impliqué dans la valorisation de fauteuils roulants (n=9), des utilisateurs de fauteuils valorisés (n=20) et des ergothérapeutes issus d'autres établissements de santé référant des clients (n=5). Résultats. Une approche qualitative auprès du 1er groupe a permis de mettre en évidence plusieurs inefficacités aux plans structurel (ex. ressources insuffisantes pour la collecte des fauteuils inutilisés), opérationnel (ex. absence de normes pour la remise en état des fauteuils), stratégique (ex. absence de politique pour inciter le retour des fauteuils) et systémique (ex. absence d'imputabilité de L'État au niveau des responsabilités). Une approche quantitative auprès des 2e et 3e groupes a permis de révéler un degré élevé de satisfaction pour l'efficacité, l'apparence, la sécurité, la durabilité et le confort des fauteuils ainsi pour le service d'attribution et le suivi post-attribution. Conséquences pour la pratique. La procédure d'évaluation de programme peut être généralisée à d'autres contextes similaires pour que les décideurs documentent rapidement l'efficacité des procédures de valorisation des aides techniques en vigueur dans leur établissement.
Compliance with Administration Procedures of Tests for Children with Pervasive Developmental Disorders: Does it Exist?
Authors: Stuhec Victoria , Gisel Erika G.
Published: March 2013

Background. There are no specific tools to evaluate functional performance that accommodate the special needs of children with pervasive developmental disorders (PDD). Method. Pediatric occupational therapists in Quebec were surveyed to identify assessments that are currently being used, the modifications made, and the use of results for treatment planning and service recommendations. Results. Results from 59 therapists treating children with PDD indicated that 52 different assessments, both standardized and non-standardized, were used. Standardized tests were used infrequently and were rarely administered without modifications. Equal weight is attributed to the results from standardized and non-standardized tests and clinical observations for the purpose of treatment planning and services. Practice Implications. This study highlights the need for practice parameters that would guide the assessment process and create a consensus among therapists and practice centres.
A Framework of Strategies for Client-Centred Practice
Authors: Restall Gayle , Ripat Jacquie , Stern Marlene
Published: March 2013

Background. Implementing strategies to overcome barriers to client-centred practice is a challenge encountered by many occupational therapists in their daily practice. The Client-centred Strategies Framework is proposed as a tool to assist occupational therapists to consider barriers and implement strategies from a variety of perspectives. Description. The framework consists of five categories: personal reflection, client-centred processes, practice settings, community organizing, and coalition advocacy and political action. Within each category are a number of actions that can be taken to facilitate client-centred practice. This paper describes the framework with elaboration of each of the five categories. A case example is used to illustrate how a therapist can use the framework to address client-centred practice issues. Practice Implications. This framework will assist therapists and students to problem-solve ways to enhance the use of client-centred processes within their own practice environments.
The Effectiveness of Community-Based Occupational Therapy Education and Functional Training Programs for Older Adults: A Critical Literature Review
Authors: Wilkins Seanne , Jung Bonny , Wishart Laurie , Edwards Mary , Norton Shelley Gamble
Published: March 2013

Background. This paper examines the results of a critical literature review describing the provision of education and functional training programs by occupational therapists with older adults to maximize their occupational performance. Purpose. The critical review addressed the following question: What is the effectiveness of education and functional training programs in improving occupational performance and quality of life for older adults? Review methods are described and the outcomes of the critical review discussed. Results. The results indicate that there is evidence that programs are effective in three areas: prevention of functional decline and falls, stroke and rheumatoid arthritis. Methodological limitations exist in some studies. There are several randomized controlled studies in this area, though the description of specific occupational therapy interventions is often vague and the programs could not be easily duplicated by occupational therapists. Practice implications. Occupational therapists are provided with information through this critical review to facilitate evidence-based practice when working with older adults.
Theory of Research Utilization Enhancement: A Model for Occupational Therapy
Authors: Craik Janet , Rappolt Susan
Published: March 2013

Background. There is a pressing need for occupational therapists to provide research-based practice, yet there is little understanding of the specific strategies and processes individual practitioners use to integrate research evidence into their clinical practice. Method. Using grounded theory method, the self-reported research utilization strategies of a sample of 11 elite occupational therapists practicing in adult stroke rehabilitation were examined. The triangulation of the interview data, the organizational policies of their workplaces, and existing theoretical concepts and processes of research utilization resulted in the development of a theory and a practice model to guide research utilization in occupational therapy. Results. The Theory of Research Utilization Enhancement for Occupational Therapists, and the Model of Research Utilization in Occupational Therapy are presented, and their implications for practice, policy, education and future research are discussed. Practice Implications. Built upon the Occupational Performace Process Model, the theory and model are proposed as guides to enhance therapists' ability to maintain a client-centred approach while informaing clinical practices with research evidence. The application of structured reflection, case application and peer consultation facilitate the integration of research evidence into clinical practices.
Occupational Value among Individuals with Long-Term Mental Illness
Authors: Eklund Mona , Erlandsson Lena-Karin , Persson Dennis
Published: March 2013

Purpose. The study compared the perceived value of occupation among a sample of individuals with long-term mental illness to a sample of people not diagnosed with mental illness. As well, it investigated whether diagnostic and demographic factors were related to perceived occupational value among the individuals with mental illness. Finally, the study examined the relationship between occupational value and ratings of health and well-being. Method. One hundred and three individuals with mental illness and 28 healthy individuals were recruited for the study. Results. Overall occupational value among the individuals diagnosed with mental illness differed only marginally from the healthy group, indicating that perceived occupational value was by and large not related to mental illness. Among the individuals with mental illness, having children living at home was related to occupational value. There were moderate to strong associations between occupational value and measures of health and well-being. Practice Implications. This study provides important insights into occupational value among individuals with persistent mental health problems and provides some preliminary evidence in support of the Value, Meaning and Occupation Model.
Functional Assessment of Injured Workers: A Profile of Assessor Practices
Authors: Strong Susan , Baptiste Susan , Cole Donald , Clarke Judith , Costa Marcos , Shannon Harry , Reardon Rhoda , Sinclair Sandra
Published: March 2013

Background. Considerable controversy and limited information surrounds the use of performance-based functional assessments for determining an injured worker's ability to function at work. Purpose. Amidst a variety of protocols, philosophies and tools, the key aspects of different assessment approaches are described and compared across a range of assessment provider organizations. Method. Qualitative and quantitative strategies were used to generate an in-depth understanding of the different assessment practices among 23 Southern Ontario assessment providers. Results. Assessment approaches share common elements and variations that can be described along the continua of five dimensions: nature of assessor-evaluee interactions, fixed or flexible protocol delivery, efforts to contextualize, perceptions and use of evidence, and provider organizational environment. These approach dimensions are offered as a focus for appraising practices. Practice Implications. Assessors need to reflect upon to what extent they are using a whole person, client-centred approach directed by clinical reasoning amidst a market driven industry.
In the Eye of the Dragon: Women's Experience of Breast Cancer and the Occupation of Dragon Boat Racing
Authors: Unruh Anita M. , Elvin Natalie
Published: March 2013

Background. Women with breast cancer are at risk of developing lymphedema following surgical and/or medical treatment of the disease. Recently, women have challenged traditional advice about limiting upper extremity activity to prevent lymphedema by participation in dragon boat racing. Purpose. In this qualitative pilot study, three women were interviewed about the meaningfulness of dragon boat racing in their lives. Methods. The women were interviewed twice and their interviews analyzed using thematic analysis. Results. Seven themes are discussed: attraction of dragon boat racing; physical and emotional well-being; competition; social support; transcendence/connectedness/oneness; re-occurrence of cancer; and, public awareness. Competition enabled the participants to rebuild self-confidence and to regain control over their physical health and emotional well-being. Balancing support and competition was key to finding satisfaction in this occupation. The women did not believe that dragon boat racing affected their risk for developing lymphedema. Practice Implications. People who engage in the occupation of dragon boat racing find it meaningful and develop new coping strategies. Participating in dragon boat racing can decrease stress and shift the meaning of having breast cancer to a more positive view of the experience.
Assistive Technology and Handwriting Problems: What do Occupational Therapists Recommend?
Authors: Freeman Andrew R. , MacKinnon Joyce R. , Miller Linda T.
Published: March 2013

Background. Handwriting difficulties for students are a common reason for referral to occupational therapy. Little research evidence is available concerning the factors guiding technology recommendations for these children. Purpose. The objective of this survey research was to describe the technology-related recommendations and factors involved in the decisions made by Canadian occupational therapists for these students. Results. More therapists recommended the use of keyboard-based strategies (93%) than dictation-based strategies (72%). Experienced therapists were more likely to prescribe technology tools. Dictation to a scribe (93%) and desktop computers (89%) were the strategies most frequently recommended. Equipment cost and availability of funding, and the availability of support in the school for the student were the most influential factors, respectively, on the keyboard and dictation strategy type prescribed. Practice Implications. The results confirmed that occupational therapists prescribe a range of technology solutions. Factors influencing these recommendations differ depending on the nature of the technology, the person, environment or occupation. Knowing the factors guiding occupational therapist technology recommendations will help provide valuable information about the practical implications of the available technologies.