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Influence
of Occupation on Health and Well-Being in Adults (Part II)
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As promised, here is the second half of:
Link between Activities, Occupation and/or
role engagement
and Health or Quality of Life
References from 1990
Selected from OT SEARCH, July 18, 2003 and August 19, 2003
Aubin, G., Hachey, R., & Mercier, C. (1999). Meaning
of daily activities and subjective quality of life in people
with severe mental illness. Scandinavian Journal of Occupational
Therapy, 6, 53-62.
The occupational therapy services for adults with severe
and persistent mental illness are concerned with their quality
of life. A correlational study explored the relationship between
the meaning of daily activities and the subjective quality
of life of this group of people. In this study, the meaning
of activities was defined by three elements, related to the
Human Occupation Model: perceived competence, value and pleasure,
measured by the Occupational Questionnaire. The Wisconsin
Quality of Life-Client Questionnaire provided a global score
for the subjective quality of life. A total of 45 people with
severe and persistent mental illness, living in downtown Montreal,
participated in a semi-structured interview. The results suggest
that perceived competence in daily tasks and rest, and pleasure
in work and rest activities are positively correlated with
subjective quality of life. The influence of occupation and
its meaning on quality of life, an occupational therapy assumption,
is supported by these results. It also supports occupational
therapists' interventions with these clients when aiming to
help develop their sense of competence and their enjoyment
in the performance of activities.
Baum, C.M. (1995). The contribution of occupation to function
in persons with Alzheimer's Disease. Journal of Occupational
Science: Australia, 2, 59-67.
Occupation is known to play an important role in the maintenance
of health. No study has explicitly explored the role that
occupation (defined as continued engagement in instrumental,
leisure and social activities) plays in the maintenance of
self care skills and management of disturbing behaviors in
individuals with dementia of the Alzheimer's type (DAT), nor
has the relationship of memory, executive skills, and occupation
been studied in this population. Seventy two couples, one
spouse with DAT, were studied to explore these relationships
and the role that occupation plays in their function. Individuals
who remained active in occupation demonstrated fewer disturbing
behaviors, required less help with basic self care, and their
carers experienced less stress. Theoretical implications of
findings are discussed.
Bedell, G. (1998). Finding balance: The daily lives of urban
gay men with HIV/AIDS. New York, New York: New York University.
(Doctoral Dissertation)
This study explored what daily life was like for eight gay
men with HIV/AIDS living alone in New York City. Information
about their daily life experiences was collected and analyzed
using qualitative research methods. Data was collected using
in-depth interviews and observations of the participants'
home environments. This data was recorded and stored in a
field log, which included interview transcripts, field notes
and analytic memos. Constant-comparison and thematic analysis
was used to identify categories and themes from the data that
elucidated the participants' individual and shared daily life
experiences. Four major themes and one overarching metatheme,
"It's
About Finding Balance in My Life," emerged from data
analysis. The participants described the importance of having
adequate financial resources and social supports. They also
had to reconstruct their daily activities and routines due
to HIV/AIDS-related factors. Work and the redefinition of
work had a significant influence on the participants' lives.
Activities that involved sharing something of themselves to
others had become important such as establishing intimate
relationships, doing creative projects, or helping sick friends
or others in the community. Daily life entailed dealing with
vast amounts of symptoms, treatments, side effects, information,
and services. Dealing with fears, uncertainties, loss, and
stigma was clearly a part of living with HIV/AIDS as well.
The participants described some common and diverse experiences
in their lives related to being gay men with HIV/AIDS such
as disclosing their sexual orientation and HIV status, coming
to terms with HIV/AIDS, caring for sick friends or lovers,
and attending many funerals and memorial services. There were
numerous examples of their attempts to find balance in their
lives. This was illustrated by paying attention to physical
and emotional signs of health and illness, modifying activities
and life goals, managing resources, letting others help, and
rethinking what they needed or wanted to do on a daily basis.
The implications these findings have for consumers and health
professionals were discussed in relation to service delivery,
and assisting individuals with HIV/AIDS and other chronic
illness with finding and maintaining balance in their lives.
Carlson, M., Clark, F. & Young, B. (1998). Practical
contributions of occupational science to the art of successful
ageing: how to sculpt a meaningful life in older adulthood.
Journal of Occupational Science, 5, 107-118.
Given that the longevity revolution has already arrived
and will continue to flourish in the upcoming decades, Western
societies are confronted with the urgent challenge of promoting
the goal of successful ageing for untold millions of citizens.
With regard to this goal, current thinking points to the optimistic
conclusion that potentially controllable lifestyle factors
play a crucial role in enabling people to experience health
and satisfying lives well into older adulthood. In this paper,
the importance of occupation as providing a fundamental, personally
relevant context for the enactment of sustainable lifestyle
choices that foster successful ageing is described. This stress
on the significance of occupation is supported by the successful
outcome of an experimental test of a preventive occupational
therapy intervention designed to promote health and psychosocial
well-being in community dwelling elders. Based on the theory
and research that is discussed, a practically oriented synthetic
overview is provided of the conditions conducive to successful
ageing.
Christiansen, C.H. (2000). Identity, personal projects and
happiness: self construction in everyday action. Journal of
Occupational Science, 7, 98-107.
This study reviewed archival data from 120 adults ages 19-79
in order to explore the identity-related dimensions of their
personal projects. Influenced by recent findings in action
psychology that suggest a key link between the identity dimensions
of projects, and both meaning and happiness or subjective-well
being (SWB), it was hypothesized that project ratings on various
dimensions would show the central influence of self-identity
within project systems and significantly predict SWB. Analysis
of factors extracted from project dimensions revealed that
projects influence happiness based on their beneficial impact
and their ability to enable self-expression, demonstrate social
significance, and reflect confidence. The challenge offered
by a project and the overall effort required completing it
also account for variance in measures of well-being. For the
overall sample, the self-expression factor emerged as a significant
predictor of SWB. When individual sub samples grouped by age
were analyzed, different patterns emerged. Only the perceived
social significance of projects emerged as a predictor of
SWB in all three age groups. Additional analyses designed
to explore the project dimensions of integrity (being genuine)
and efficacy (getting the job done) were also conducted. These
also showed differences among the subgroups, which were interpreted
in light of developmental theories of adulthood. Overall,
the findings supported a constructionist view that goal directed
projects provide important opportunities for shaping identity.
Christiansen, C.H., Backman, C., Little, B.R., & Nguyen,
A. (1999). Occupations and well-being: a study of personal
projects. The American Journal of Occupational Therapy, 53,
91-100.
OBJECTIVE. The purpose of this study was to explore the
relationship between occupation and subjective well-being
(SWB). METHOD. A convenience sample of 120 adults completed
a personal projects analysis, a method of rating their current
goal-directed pursuits. They also completed measures of SWB
(Affect Balance Scale, Life Satisfaction Index Form A) and
personality traits (Myers-Briggs Personality Inventory). Characteristics
of personal projects were correlated with SWB scores. Multiple
regression analysis was used to investigate possible predictors
of well-being from among the characteristics of personal projects,
personality traits, and demographic variables. RESULTS. The
stress associated with personal projects was significantly
and inversely correlated with well-being, as was project difficulty.
Perceived progress in completing projects was significantly
positively correlated with well-being. The strongest predictors
for well-being were the composite project factors of stress
and efficacy. Two personality traits, sensing and extraversion,
interacted with the project dimension of stress to emerge
as significant predictors of well-being. Together, these four
variables explained 42% of the variance in well-being scores.
CONCLUSION. These findings are consistent with assumptions
that attributes of meaningful occupations are significantly
related to people's perceived well-being.
Clark, F. (1997). Reflections on the human as an occupational
being: biological need, tempo and temporality. Journal of
Occupational Science: Australia, 4, 86-92.
Global health through occupation is contingent upon our
understanding of the human as an occupational being. In this
paper, I reflect upon two aspects of the human as an occupational
being: 1) the biological need for occupation, and 2) tempo
and temporality as a way of beginning to generate a blueprint
for global health. Wilcock's theory on the human need for
occupation proposes that people living in post industrial
nations are diverted from engagement in occupations that function
to meet biological needs. The theory largely addresses the
issue of what kinds of occupations are likely to be health
promoting, given a set of assumptions about the history of
humans as occupational beings. On the surface it would appear
that occupations that resemble those of prehistoric men and
women would be optimal for promoting health and well-being,
but these kinds of occupations are largely unsuitable for
incorporation into contemporary lifestyles. Yet, there are
elements from prehistoric occupations that can be recaptured
in contemporary activity, and I speculate on the form such
occupation might take as a way of addressing the general question
of what kinds of occupations are likely to be health promoting.
The beginning blueprint for global health through occupation
must also take into account the nature of occupational beings
in relation to tempo and temporality. I argue that there is
an intersection between tempo and temporality. The tempo of
occupation is simply defined as its pace and rhythm. Temporality,
in contrast, has to do with how we understand occupation in
relation to past, present and future events. When life is
rushed as it is in the fast lane of modernity, the result
can be the forgetting-of-being, or stated otherwise, doing
without being. I suggest that a healthier people and a healthier
world could result from a blueprint generated through occupational
science research that identifies the patterns of occupation
that are likely to be maximally health promoting and the pace
at which they should be undertaken.
Clark, F., Carlson, M., Zemke, R., Frank, G., Patterson,
K., Ennevor, B.L., Rankin-Martinez, A., Hobson, L.A., Crandall,
J., Mandel, D., & Lipson, L. (1996). Life domains and
adaptive strategies of a group of low-income, well older adults.
The American Journal of Occupational Therapy, 50, 99-108.
Older adults are at increased risk for a variety of physical
and functional limitations that threaten their ability to
lead independent and fulfilling lives. Consequently, they
stand to benefit from personalized strategies of adaptation
that enable them to achieve successful outcomes in their daily
activities and desired goals. In the current investigation,
a qualitative descriptive methodology was used to document
the perceived life domains of importance and associated strategies
of adaptation of 29 residents of Angelus Plaza, a federally
subsidized apartment complex in downtown Los Angeles for low-income,
well older adults. On the basis of interview data, 10 life
domains were identified, and within each domain, a typology
of adaptive strategies was derived. The domains were activities
of daily living (ADL), adaptation to a multicultural environment,
free time usage, grave illness and death - spirituality, health
maintenance, mobility maintenance, personal finances, personal
safety, psychological well-being and happiness, and relationships
with others. Although the typology should not be generalized
to a geriatric population, therapists may wish to refer to
it to gain a sense of the extent to which certain adaptive
strategies may be applicable to the lives of particular older
adults to whom they deliver services. The teaching of these
adaptive strategies could then be incorporated into an individualized
treatment plan. The typology also provides a broad picture
of the kinds of adaptive strategies used by the older adults
as a way of coping and adapting to their setting. Although
some of the domains do not differ from those typically addressed
in occupational therapy textbooks on geriatric care (e.g.,
ADL, health maintenance), others seem uniquely tailored to
the specifics of the Angelus Plaza context (e.g., personal
safety). Finally, certain domains emerged that may be highly
relevant to older adults in most settings but are not typically
the focus of occupational therapy programs (e.g., grave illness
and death - spirituality, relationships with others). The
emergence of these domains from our data suggests that therapists
may wish to consider them more in treatment if they are convinced
that they possess local relevance.
Classen, S. (2001). The long-term effectiveness of two occupational
therapy interventions on the lives of people MS: A randomized
controlled trial. Ft. Lauderdale FL: Nova Southeastern University.
(Doctoral Dissertation)
Statement of the Problem: Multiple sclerosis (MS) is the
most common demyelinating disease of the central nervous system.
It affects over 2.5 million people worldwide and approximately
350,000 Americans with new cases diagnosed weekly. MS significantly
impacts activity participation, general health status, and
quality of life. An extensive literature review reveals a
gap in the rehabilitation programs or occupational therapy
wellness programs to improve the activity participation, general
health and well-being, and quality of life for people living
with MS. Methods: This randomized controlled trial (RCT) compared
the long-term impact of an occupational therapy rehabilitation
program, an occupational therapy wellness program, and a social
activity program (control), on the occupational performance,
general health and well-being, and quality of life of people
living with MS, through repeated measures. Assessment tools
used to measure occupational performance, general health and
well-being and quality of life were the Occupational Self-Assessment,
the SHORT Form-36 version 2 and the Quality of Life Inventory.
Quality of life is a primary outcome in the provision of healthcare
services for the chronically ill, and is the predominant measure
in this clinical research, hence the choice of these assessment
tools. Results: The effect of each of the group programs,
rehabilitation, wellness and a social activity group was compared.
Data were analyzed with MANOVA. The results yielded that the
occupational therapy wellness group demonstrated a statistically
significantly positive difference in the mental component
summary measure of the SF-36v2 over the occupational therapy
rehabilitation group (p=.093), two months post intervention.
The results further revealed that the occupational therapy
wellness group demonstrated a statistically significantly
positive difference in the environmental impact scale of the
OSA over the occupational therapy rehabilitation group (p=.15)
and the social activity group (p=.065), over a period of three
months. Conclusions: In this study an occupational therapy
wellness approach showed statistically significantly positive
effects on the environmental impact and mental health of people
with MS over the long-term. This study also demonstrated the
clinical significance associated with an occupational therapy
rehabilitation and an occupational therapy wellness approach.
These findings therefore contribute to evidence-based practice
for the most effective occupational therapy interventions
for persons with MS.
This study was supported by grant #NSU012001 from the National
Sclerosis Foundation and the Nova Southeastern University
President's Scholarship Award 2001.
Coyle, C.P., Lesnik-Emas, S., & Kinney, WB. (1994). Predicting
life satisfaction among adults with spinal cord injuries.
Rehabilitation Psychology, 39, 95-112.
This study examined life satisfaction among 91 adults with
spinal cord injury (SCI) through structured personal interviews
that used the Center for Epidemiological Studies Depression
Scale, Rosenberg's Self-Esteem Scale, the Life 3 Measure,
and a number of items related to satisfaction with various
life domains. Results suggest leisure satisfaction was the
most significant predictor of life satisfaction, explaining
43% of the variance in the life satisfaction scores; an additional
16% of the variance was explained by self-esteem and health
satisfaction. Findings highlight the role of leisure satisfaction
in enhancing life satisfaction among individuals with SCI,
given the high unemployment rate in this population. Discussion
centers on the potential contributions of therapeutic recreation
and leisure education services for individuals with SCI during
their acute rehabilitation and upon community reentry.
Eklund, M. (2001). Psychiatric patients' occupational roles:
Changes over time and associations with self-rated quality
of life. Scandinavian Journal of Occupational Therapy, 8,
125-130.
This study investigated psychiatric patients' occupational
roles before and after a period of treatment in occupational
therapy day-care and at a 1-year follow-up. Furthermore, associations
between valued occupational roles and self-rated quality of
life were investigated. Twenty patients with a mean age of
30 years and diagnosed with a psychosis diagnosis or other
long-term mental illness were followed during treatment, in
average 16 months, and 1 year after. The profile of occupational
roles for the group as a whole pointed to that home maintainer,
family member, hobbyist, and friend were roles that were held
and valued by more than half of the respondents. The number
of valued roles increased significantly from admission to
discharge and follow-up. Five out of eight valued roles, friend,
hobbyist, worker, family member, and caregiver showed associations
with quality of life, and the relationship of friend to quality
of life was most consistent over the three measurement points.
No association was found between occupational roles and a
general measure of mental health. Even though the number of
valued roles increased, however, the pattern of roles remained
fairly similar over the three occasions, and the picture deviated
from results from studies on general populations of similar
ages on, e.g. the proportion of respondents holding a worker
role and a caregiver role.
Forward, GE. (1995). SOUNDING BOARD: A survey of continued
productive activity in those over the expected retirement
age. Work: A Journal of Prevention, Assessment & Rehabilitation,
5, 71-74.
This article discusses the results of a study done in England
that examined the activity involvement of people > 60 years
of age. Data were gathered through surveying two local newspapers,
face-to face contacts, telephone calls, and letters. Areas
examined included health and community welfare, education,
politics, legal matters, religious affairs, business, environmental
issues, and creative activity. Results found that many of
the community's older people are productively occupied in
these various areas. Positive and negative influences on their
involvement are discussed, as well as ways of increasing older
people's involvement in the future.
Guinn, B. (2001). Psychological constructs of activity readiness
in high functioning elderly. Activities, Adaptation &
Aging, 25, 137-147.
This study examined the relationship of activity readiness
with self efficacy, perceived behavioral control, exercise
attitudes, self-rated health, and selected demographic variables
among high functioning, independent-living elderly. Four hundred
seventy-one subjects, ranging in age from 62-93 years, were
drawn from a popular retirement area and data were gathered
through a self-report survey instrument. Subjects residing
at no exercising readiness stages held negative self-efficacy,
behavioral control, and attitudinal beliefs whereas regular
exercisers held positive beliefs toward these constructs.
Perceived behavioral control was most indicative of active
lifestyle attainment, suggesting that intervention strategies
designed to initiate and maintain activity in the high functioning
elderly should focus on control belief cognitions.
Hachey, R., Boyer, G., & Mercier, C. (2001). Perceived
and valued roles of adults with severe mental health problems.
The Canadian Journal of Occupational Therapy, 68, 112-120.
The purpose of this article is to convey the findings of
two studies related to the perception of past, present and
future roles, the value attributed to these roles as well
as the role patterns. Both studies were conducted with adults
who have schizophrenia and are involved in a rehabilitation
or work program. Data were collected from two sources: 1)
secondary analysis of a study related to the methodology for
validating the French translation (Hachey, Jumoorty, &
Mercier, 1995) of the "Role Checklist" (Barris,
Oakley, & Kielhofner, 1988) and 2) a research project
on the perception of roles and quality of life. Results showed
that the dominant roles assumed by participants regardless
of time were family member, friend, home maintainer and hobbyist.
The most valued roles were those of friend, worker, and family
member. The discussion will address the questions asked and
elucidate the role patterns. The conclusion underlines the
importance, for occupational therapists and health professionals,
of including roles in the daily lives of their clients, taking
into consideration the ones they value most highly.
Hammel, J. (2000). Assistive technology and environmental
intervention (AT-EI) Impact on the activity and life roles
of aging adults with developmental disabilities: findings
and implications for practice. Physical & Occupational
Therapy in Geriatrics, 18(1), 37-58.
As persons age with developmental disabilities, they experience
life long disability and age-related issues at the impairment,
activity, participation and environment levels. Assistive
technology and environmental interventions (AT-EI) can serve
as potential mediators in delaying or preventing functional
decline, health conditions, and dependent care placements
only if they are considered within the dynamic interaction
of the person, activities, and the facilitators and barriers
within the social and physical environment. This paper summarizes
AT-EI needs, research results, and implications for practice
specific to persons with developmental disabilities, and important
others in their lives, as they age in place.
Hasselkus, B.R. (2002). The meaning of everyday occupation.
Thorofare, NJ: SLACK, Inc.
Hasselkus, B.R. (1998). Occupation and well-being in dementia:
the experience of day-care staff. The American Journal of
Occupational Therapy, 52, 423-434.
OBJECTIVE. The purpose of this study was to gain understanding
of the staff experience of occupation in the context of day
care for persons with dementia. METHOD. Narratives of especially
satisfying and dissatisfying experiences of care were elicited
from a random state-wide sample of day-care staff members.
Qualitative methods were used to analyze the phenomenological
data. RESULTS. The core meaning of occupation derived from
these data was Occupation as the Gateway to Relative Well-Being.
A model of the experience 0f occupation for staff members
is proposed that is composed of three phases: the meeting
of minds, engagement in occupation, and relative well-being.
The skills of the staff informants that bring about the meeting
of minds, the many levels of client engagement in occupation,
and the indicators of well-being for clients and for staff
members are described. The three phases together constitute
an occupational space -- created by the staff person - and
the engagement in occupation itself constitutes an occupational
place within that space. CONCLUSIONS. Bringing about indicators
of well-being through occupation was a primary source of satisfaction
for the day-care staff informants in this study, The model
of the staff experience of occupation proposed in this study
has application to all areas of occupational therapy practice.
Hillman, A.M. & Chapparo, CJ. (1995). An investigation
of occupational role performance in men over sixty years of
age, following a stroke. Journal of Occupational Science:
Australia, 2, 88-99.
Life roles can be seen as social, cultural and occupational
roles. Occupational roles are patterns of self maintenance,
work, leisure and rest activities that are done on a regular
basis and are strongly associated with social cultural roles.
Occupational role performance is the way that activities linked
to these roles are carried out. It is proposed that occupational
role performance has direct relationship to lifestyle and
health issues. Very little is known about the occupational
roles of the elderly, and nothing is known about the way elderly
people who have had a stroke organise their daily activities
following discharge from rehabilitation programs. The purpose
of this study was to gather information about the self-perceived
occupational role performance profiles of elderly men who
have had a stroke and are living at home. This information
will be utilised in subsequent research into factors that
influence occupational role performance in the elderly. Although
role assessment instruments have been developed for adults
and the elderly they have limitations in the scope and type
of information they provide. Using an interview process, information
gathered in this study related specifically to the participants'
own perceptions of their current role performance in the areas
of productivity, self maintenance and leisure, as well as
aspects of their socio-cultural role performance. Perceived
frequency of performance, perceived role value and degree
of satisfaction with role performance was discussed and evaluated
for each of these areas. Preliminary results from seven interviews
are presented here.
Honaker, D.K. (1999). The impact of occupational activities
and wellness in elders. Texas Woman's University: Denton,
TX. (Master's Thesis)
Through literature review and a mixed design study, this
paper attempts to evaluate the patterns of adaptation that
elders with rheumatoid arthritis make when faced with occupational
challenges. The three research questions for this study include:
1) What are the ways in which elders with arthritis adapt
in order to engage in meaningful occupations? 2) Do these
elders experience a sense of mastery with regard to these
occupations as defined by efficiency, effectiveness and satisfaction
to self/others? 3) Is there a perceived relationship between
engaging in preferred occupations and the degree to which
these elders feel pain? Results indicated that most of these
elders continued to pursue many of their desired activities
in spite of the pains of rheumatoid arthritis and believed
that keeping active relieved the symptoms of arthritis; however
many of the elders did not feel that they were as efficient
or effective at their tasks.
Huebner, R.A., Johnson, K., Bennett, C.M., & Schneck,
C. (2003). Community participation and quality of life outcomes
after adult traumatic brain injury. The American Journal of
Occupational Therapy, 57, 177-185.
OBJECTIVE. This study examined outcomes after traumatic
brain injury in adults salient to occupational therapy. METHOD.
Demographic data and Functional Independence Measure (FIM)
scores from the inpatient rehabilitation stay were first gathered
from a retrospective chart review. At follow-up, 25 adults,
on average 21 months post-injury, completed measures of disability,
community participation, quality of life, and satisfaction
with occupational therapy during a telephone interview. Analysis
of covariance was used to test the differences between pretest
and posttest scores on the FIM; regression analysis and correlations
were used to analyze predictions and relationships. RESULTS.
Statistically significant improvements in FIM scores during
rehabilitation were predictive of the level of long-term disability
and community participation among participants. At follow-up,
participants were often unemployed, depressed and withdrawn,
and experienced limitations in decision making, hand use,
bladder control, and community integration. Less disability
and more community participation were related to higher quality
of life. Satisfaction with occupational therapy, although
high, was unrelated to most outcomes. CONCLUSION. Results
support the premise that participation is associated with
a high quality of life, yet persons with brain injury have
significant needs for long-term occupational therapy.
Hull, J.B. (1998). The association of engagement in meaningful
roles and life satisfaction in older adults after physical
rehabilitation. Philadelphia, PA: Temple University. (Master's
thesis)
With continued expected growth of the United States population
over age sixty-five and the corresponding high demands on
health care and community resources with increasing age and
frailty, there is a growing demand for outcome measures and
studies to allow older adults to choose services that maximize
quality of care at minimum cost. Outcomes to judge effectiveness
or quality of rehabilitation services have expanded beyond
historical measures of increased independence in daily living
skills and decreased length of hospital stay to include personal
values such as improved life satisfaction. A convenience sample
of ninety-nine adults age sixty-five or older discharged to
the community with a primary caregiver within the past fourteen
months was obtained from the discharge data base of a large,
urban rehabilitation hospital. Data was collected through
telephone administration of the Moss Occupational Role Assessment
(MORA) and the Life Satisfaction Index-A (LSI-A) as part of
a larger study during July and August 1996. Correlations between
scores obtained on the Moss Occupational Role Assessment and
scores obtained on the Life Satisfaction Index-A were calculated
using the Spearman Rho Rank Order Correlation Test. There
was a moderate positive correlation significant at level p=<
.01 found between life satisfaction and meaningful role involvement
but no significant correlation between life satisfaction and
hours of role involvement for the community-living older adult
after discharge from inpatient rehabilitation. These results
support the importance of restoring meaningful role involvement,
as defined by the individual, in order to maximize life satisfaction
as an outcome measure of physical rehabilitation. They also
support the inclusion of life satisfaction and role performance
data in the development of interdisciplinary uniform data
systems to assess effectiveness of different interventions
on rehabilitation outcome measures valued by consumers.
Iwarsson, S., Isacsson, A., Persson, D., & Schersten,
B. (1998). Occupation and survival: a 25-year follow-up study
of an aging population. The American Journal of Occupational
Therapy, 52, 65-70.
OBJECTIVE. In this retrospective study of an elderly population
cohort living in a defined Swedish rural area, the relationship
between occupation and survival as a measure of objective
health was investigated. The cohort has been followed for
25 years. METHOD. On the basis of the baseline socioeconomic
interview from assessments performed when the participants
were 67 years of age, an index of active participation in
daily occupation was devised. The index was used to investigate
the covariation between generic everyday occupation and long-time
survival. RESULTS. For the female participants, Kaplan-Meier
curves demonstrated differences in survival between the "less-active"
and "more-active", and Cox regression survival analyses
resulted in a significant covariance between occupation and
survival. For the male participants, no such differences were
found. CONCLUSION. The significant results for the women implied
support for the core assumption of occupational therapy that
a relationship exists between occupation and health. The lack
of differences in survival among more active and less active
men demonstrates the complexity of studying occupation.
Jackson, J., Carlson, M., Mandel, D., Zemke, R., & Clark,
F. (1998). Occupation in lifestyle redesign: The well elderly
study occupational therapy program. The American Journal of
Occupational Therapy, 52, 326-336.
This article describes an innovative preventive occupational
therapy intervention for well older adults, the Well Elderly
Treatment Program. In a previously reported large-scale randomized
effectiveness study, this intervention was found to be highly
successful in enhancing the physical and mental health, occupational
functioning, and life satisfaction of multicultural, community-dwelling
elders. In this article, the philosophical background, manner
of development, topical content, methods of program delivery,
and mechanisms underlying the program's positive effects are
discussed, along with implications for occupational therapy
practice. The treatment was based on application of occupational
science theory and research and emphasized the therapeutic
process of lifestyle redesign in enabling the participants
to actively and strategically select an individualized pattern
of personally satisfying and health-promoting occupations.
The wide-ranging effectiveness of the program supports the
occupational therapy profession's emphasis on occupation in
affecting health and positions practitioners to extend their
services to the realm of preventive interventions.
Laliberte-Rudman, D., Yu, B., Scott, E., & Pajouhandeh,
P. (2000). Exploration of the perspectives of persons with
schizophrenia regarding quality of life. The American Journal
of Occupational Therapy, 54, 137-147.
Objective: This study is the first phase of a two-phase
study aimed at exploring the perspectives of consumers with
schizophrenia regarding quality of life and developing a quality-of-life
assessment that addresses factors experienced as important
by consumers. METHOD. Focus groups were used to explore the
perspectives of 35 persons with schizophrenia regarding the
meaning of quality of life and factors important to quality
of life. RESULTS. Seven major factors that had an impact on
quality of life resulted from inductive analysis, including
activity, social interaction, time, disclosure, "being
normal", finances, and management of illness. These factors
relate to three overall themes; managing time, connecting
and belonging, and making choices and maintaining control.
CONCLUSIONS. Although the findings confirm the importance
of factors included in existing quality-of-life assessments,
they also highlight the need to look at new dimensions of
commonly included factors and to include other factors. The
findings support beliefs regarding occupation that are central
to occupational therapy and the use of occupation as means
and ends of therapy. Key words: human activities and occupations,
mental health, qualitative method.
Law, M. (2002). Distinguished Scholar Lecture: Participation
in the occupations of everyday life. The American Journal
of Occupational Therap, 56, 640-649.
Participation or involvement in everyday occupations is
vital for all humans. As described by the World Health Organization,
participation has a positive influence on health and well-being.
The presence of disability has been found to lead to participation
that is less diverse, is located more in the home, involves
fewer social relationships, and includes less active recreation.
Occupational therapy is in a unique position to contribute
to the development and fulfillment of participation for persons
with and without disabilities. This article describes the
nature and outcomes of participation. Characteristics to define
and measure meaningful participation are outlined. Information
about time use will help to develop an understanding of patterns
of participation across locations, gender, culture, and the
life span. Factors that affect participation within the environment,
family, and persons are summarized. Occupational therapy research
is needed to examine the complex relationship among person,
environment, and participation in occupations. In practice
and education, knowledge about participation can enhance the
client-centered and evidence-based nature of occupational
therapy services.
Law, M., Steinwender, S. & Leclair, L. (1998). Occupation,
health and well-being. The Canadian Journal of Occupational
Therapy, 65, 81-91.
Occupational therapists believe that there is a relationship
between occupation, health and well-being but there is little
evidence in the occupational therapy literature to support
this belief. This paper describes the results of a critical
review of research examining the relationship between occupation
and health and well-being. Twenty-two studies from the health
and social sciences literature were reviewed using specific
methodological review criteria. The findings of these studies
provide moderate to strong evidence that occupation has an
important influence on health and well-being. Because most
of this research has been completed with persons without disabilities,
further research is required to explain the nature of the
relationship between occupation and health and well-being
for persons who experience a disability which affects their
daily occupations.
Levy, L.L. (1990). Activity, social role retention, and the
multiple disabled aged: strategies for intervention. Occupational
Therapy in Mental Health, 10(3), 1-30.
This article presents an overview of concepts used by therapists
and caregivers in rehabilitation of the physically and cognitively
disabled elder to facilitate participation in valued life
activities and social roles. Intervention strategies are described
that are responsive to a central dilemma in the gerontological
literature: the mismatch between the strengths and capacities
of the aged and the lack of role opportunities to utilize
and sustain those strengths. An analytic framework of the
relationship between activity adaptations that compensate
for physical limitations and those that compensate for cognitive
limitations is presented as a guide in designing interventions
to compensate for the limitations experienced by the elder
who is both physically and cognitively disabled...
Lipschutz, E. (2000). Perceived experiences of well senior
women engaged in occupational lifestyle redesign. Ft. Lauderdale
FL: Nova Southeastern University. (Doctoral Dissertation)
Occupational lifestyle redesign is theoretically based on
the belief that humans can influence their health through
occupation and is intended to enable participants to develop
and enact a personalized array of meaningful and health-promoting
occupations. Demographic trends warrant the need for continued
exploration of interventions intended to maximize the well-being
of older adults such as occupational lifestyle redesign. This
qualitative study explored the experiences of six, well women,
aged 58-80, engaged in an occupational lifestyle redesign
program in order to explain how these women perceived the
functions of this intervention and its influences on their
well-being. Grounded theory procedures were used to construct
a theoretical model of the perceived experiences of the participants'
engagement in the eight, 2-hour, weekly sessions of the Lifestyle
Redesign Program at Nova Southeastern University (NSU). The
results of this study revealed how the participants perceived
they experienced several phenomena, expressed as functions,
that contributed to the influences on their perceived well-being.
The theoretical model illustrated the women initially experienced
an opportunity to share themselves and build connections with
one another while learning of the role of occupation in their
lives. The women became more self-aware and were able to generate
and realize occupational options that could enhance their
perceived well-being. The women then identified goals and
enacted changes related to their occupational lives. The women
subsequently revealed how the experience of these functions
of occupational lifestyle redesign influenced their perceived
well-being by facilitating: (a) their sense of connection,
(b) new perspectives about themselves and occupation and (c)
their incentive to act to maximize their lifestyles. This
study contributes to explaining how occupational lifestyle
redesign enabled its participants to explore and critique
their occupational repertoires, experience occupational options
and design plans to influence their perceived well-being through
occupation. Results of this study: (a) inform programming
aimed at promoting the well-being of well elderly through
the use of occupational lifestyle redesign, (b) support and
further explain the belief in occupational therapy that occupation
influences health and (c) demonstrate the value of studying
and explaining a phenomenon from the participants' perspectives.
Lo, J-L. & Zemke, R. (1997). The relationship between
affective experiences during daily occupations and subjective
well-being measures: a pilot study. Occupational Therapy in
Mental Health, 13(3), 1-21.
Occupational therapists assist people in developing the perception
of well-being through the selection and performance of daily
occupations. The patterns of 10 participants' daily occupational
affect experience within a week and its relationship with
their levels of well-being were investigated in this study.
The distribution pattern of affective experiences within one
week was found to be quite stable over intervals of two and
four months. The percentage of unhappy affect experiences
was found to be a better indicator of people's daily occupational
experience than the happy or neutral ones. No significant
correlations, however, were found between daily occupational
experience and levels of well-being. Possible reasons for
these results were discussed.
Lyons, M., Orozovic, N., Davis, J., & Newman, J. (2002).
Doing-being-becoming: Occupational experiences of persons
with life-threatening illnesses. The American Journal of Occupational
Therapy, 56, 285-295.
OBJECTIVE. Lifthreatening illness profoundly affects people's
occupational functioning, yet continuing occupational engagement
seems vital to their well-being. This qualitative study uses
a doing-being-becoming framework to explore the place of occupation
in human lives threatened by illness. METHOD. The experiences
of 13 male and 10 female day hospice participants were investigated
through a combination of focus groups, individual interviews,
and participant observation. These data were interpreted by
a process of constant comparison, coding, and theme building.
RESULTS. Experiences of doing were evident in accounts of
losing and maintaining valued occupations and striving to
preserve physical and mental functioning. A sense of being
through occupational engagement arose in social relationships
and self-exploration that enhanced feelings of self-worth.
Occupation promoted the experience of becoming by providing
fresh learning opportunities and a sense of contributing to
others' welfare. CONCLUSION. The data offer new insights into
the potential benefits of occupational engagement for persons
dealing with life-threatening illnesses. Use of the doing-being-becoming
framework enriched analysis of these data, which, in turn,
have contributed to the understanding of the framework's theoretical
concepts.
Macdonald, K.C. (2000). Experiences of five women adapting
to physical disability. The Israel Journal of Occupational
Therapy, 9, E39-E62.
The purpose of this research was to study the process of
adaptation to adult onset physical disability, from the perspective
of five women, fifty to sixty years of age, with varied disabilities.
A qualitative study was conducted for participants with disabilities
related to motor vehicle accident, fall, multiple sclerosis,
and diabetes. Data analysis included constant comparative
analysis, with coding and interpretation of descriptive material
into categories and themes. The data yielded four distinct
categories (personal functioning, personal relationships,
role as a patient, and managing "the system") which
were within three larger themes (self-identity, disability,
and adaptation). A final core mean period of seven years from
onset of disability, the women identified numerous challenges
and phases of adapting to altered functioning. Description
of actual techniques for acceptance and adjustment were provided,
along with recommendations to improve services, both short
and long term, in health care delivery. With ongoing personal
determination and external support, these women actively developed
means of personal fulfillment and role expansion.
Mansson, M., Fredriksson, B. & Branholm,IB. (1995). On
life satisfaction and activity preferences in long-term survivors
after stroke. Scandinavian Journal of Occupational Therapy,
2, 51-55.
The purpose of this study was to investigate the impact
of stroke on leisure and chore activities and in life satisfaction.
Sixty-one stroke patients were compared with a reference group
of 64 "healthy" individuals (mean age= 67 in both
groups). A questionnaire containing checklists about life
satisfaction and activity preferences was mailed to both groups.
Compared to the reference group, the older patients (>65
years) reported significantly lower levels of satisfaction
with life as a whole, sexual life, vocational situation, and
leisure, while the younger patients (<65 years) reported
lower levels of satisfaction with self-care ADL, leisure and
contacts with friends and acquaintances. The men and women
in the patient group reported significantly lower participation
in 22 of the 44 non-work activities. The findings are discussed
in terms of contributions that occupational therapy and rehabilitation
have to make in improving life satisfaction and enjoyment
of free time in stroke patients.
Peirce, C.C. (2001). The effectiveness of two different occupational
therapy interventions with individuals with multiple sclerosis:
A randomized controlled study. Ft. Lauderdale FL: Nova Southeastern
University. (Doctoral Dissertation)
Supported by a research grant from the Multiple Sclerosis
Foundation, this randomized controlled trial was designed
to compare the effectiveness of two occupational therapy interventions
and a social activity intervention on the lives of people
with multiple sclerosis. A multi-group pretest-posttest control
group design was used to test the hypothesis that there would
be a difference in impact between an occupational therapy
rehabilitation intervention, a social activity intervention,
and an occupational therapy wellness intervention on the occupational
performance, quality of life, and general health status of
people with MS. Multiple sclerosis affects approximately 350,000
Americans. It potentially limits occupational engagement in
activities, roles, and meaningful participation in society.
The economic impact both to the individual and to society
is estimated to be 6 billion dollars annually. The literature
described traditional occupational therapy (OT) practice for
this population and highlighted some limitations of studies
measuring the outcomes of traditional rehabilitation approaches.
The literature suggested that health promotion and wellness
approaches hold promise to improve health and quality of life
for people with MS. Therefore, in an effort to contribute
to evidence-based occupational therapy practice, two different
occupational therapy interventions were developed; one based
on the rehabilitation and biomechanical frames of reference
and the Model of Human Occupation (MOHO) and the other, a
wellness intervention, based on the Person Environment Occupational
Performance Model (PEOPM) and the MOHO. Participants were
recruited from MS membership organizations. Those who met
the inclusion criteria and who elected to participate in the
study were randomly assigned to one of the two occupational
therapy interventions or to a social activity control group.
The Occupational Self Assessment, the SF-36, and the Quality
of Life Inventory were administered at the beginning and upon
completion of 10 sessions held weekly. The results suggest
that both of the occupational therapy interventions used in
this study can have a positive impact on the health and well-being
and quality of life of people with MS, as compared to a social
activity group. The researcher concluded that further occupational
therapy research is needed that addresses quality of life
outcomes for people with MS and that other methods of assessing
occupational performance outcomes need to be explored. A number
of theoretical frameworks and models both within and outside
the occupational therapy profession are recommended to guide
the development of occupational therapy practice and outcome
studies for this population.
Reynolds, F. (2003). Reclaiming a positive identity in chronic
illness through artistic occupation. OTJR: Occupation, Participation
and Health, 23, 118-127.
This article presents a qualitative study of women's positive
reconstruction of self and identity during chronic illness
through engaging in textile artwork. Ten women volunteered
to be interviewed about the influence of their artistic occupations
on their perceived health, well-being, and identity in chronic
illness. This article specifically examines identity-related
issues within the narratives, guided by the principles of
grounded theory. The thematic analysis revealed that the participants'
engagement in art-making during illness gradually contributed
to a positive identity as a textile artist. Although emerging
after the onset of illness, the artist identity enabled each
participant to express continuities with her pre-illness self
and values. Participants also regained a positive sense of
personal growth, status, achievement, and connection with
other women, which all appeared to promote their successful
adaptation to ill health. The support of social networks and
the wider cultural milieu may have enabled participants to
commit themselves to their artwork. The findings suggest that
meaningful artistic occupation may provide a source of positive
identity for people living with chronic illness, even when
they have not engaged regularly in art in their earlier adult
lives.
Rozario, L.D. (1994). Ritual, meaning and transcendence:
the role of occupation in modern life. Journal of Occupational
Science: Australia, 1, 46-53.
The industrialised world has created a 'future shock' society
where issues of alienation, structurelessness and social disintegration
are increasing scenarios particularly for disadvantaged people.
People from all walks of life are today struggling to find
and create a sense of meaning and ritual within their lives.
This paper explores evidence from traditional cultures, modern
consciousness research, and the author's study into people
with chronic disabilities and illness, as examples of how
individuals can create a culture of health and well-being
through integrating 'being' and 'doing' within their lives.
In doing so, modern society can be revitalized by relearning
the 'art of living'.
Scott, A.H., Butin, D.N., Tewfik, D., Burkhardt, A., Mandel,
D., & Nelson, L. (2001). Occupational therapy as a means
to wellness with the elderly. Physical & Occupational
Therapy in Geriatrics, 18(4), 3-22.
Therapists, as experts in promoting independence, have a
role in providing wellness and health promotion programs in
the community. This article features several models targeting
the needs of the elderly, incorporating comprehensive functional
wellness and prevention programs by occupational therapists.
Oxford's Health Plans, Health Promotion, and Wellness department,
under the direction of an occupational therapist, has offered
cost-effective programs, including health and nutrition screening,
fall prevention, diabetes management, a sleep well/feel well
educational series, and a member led walking club. The lifestyle
redesign program emerging from the model of occupational science
is presented. Research outcomes for a randomized controlled
trial demonstrated significant benefits in a variety of health,
function and quality of life domains based on the occupational
therapy intervention with community based, culturally diverse
well-elders. Lastly, the use of T'ai Chi in the ROM (Range
of Motion) dance program reviews the health benefits of T'ai
Chi and resources available to implement this approach. Each
of these programs serves as an evidence-based model for community-based
practice. Implications for addressing public health goals
articulated in Healthy People 2010 are also discussed.
Stanley, M. (1995). An investigation into the relationship
between engagement in valued occupations and life satisfaction
for elderly South Australians. Journal of Occupational Science:
Australia, 2, 100-114.
As the population of elderly people in the Australian population
is rapidly increasing, especially the relative proportions
of people over the age of 85, our society is faced with the
challenge of planning and providing health and welfare services
that meet the needs of the elderly. This exploratory study
aimed to examine how a sample of elderly people spent their
time, and the portion of that time that was spent in valued
occupations. Relationships between engagement in valued occupations
and life satisfaction were explored. Data were collected by
subjects recording every occupation they engaged in over two
days, recording the percentage of time spent in valued occupations
and completing a life satisfaction scale. Fifty-eight subjects
living independently in the community were enrolled in the
study by a random doorknocking procedure. All subjects spent
some time in sleep, personal care and passive leisure. The
hypothesis that as time spent in valued occupations increased,
life satisfaction scores would increase, was not supported.
Life satisfaction was not correlated with any occupational
category. Gender differences were found in engagement in occupations
and in the amount of time spent alone.
Sviden, G.A. & Borell, L. (1998). Experience of being
occupied - Some elderly people's positive experiences of occupations
at community-based activity centers. Scandinavian Journal
of Occupational Therapy, 5, 133-139.
The aim of this study was to explore elderly people's positive
experiences of being occupied and spending time at community-based
activity centers. Interviews were conducted with nine elderly
persons who attended activity centers. The interviews were
analyzed by the empirical, phenomenological, psychological
method (EPP method). The constituents that describe the phenomenon
of the experience of being occupied and spending time at a
community-based activity center were: the center was a safe
and familiar setting to attend on a regular basis; doing was
absorbing and gave pleasure; it was a challenge to be able
to accomplish something; and the activity center was a meeting-place
where doing is shared with others. The study suggests that
the activity center is experienced as a meeting-place where
the social component and the engaging in an occupation are
essential for the experience and contribute to the health
and well-being of the individuals.
Watson, M.A. & Ager, CL. (1991). The impact of role valuation
and performance on life satisfaction in old age. Physical
& Occupational Therapy in Geriatrics, 10(1), 27-62.
This study examined the relationship between frequency of
performance of valued roles and life satisfaction in old age.
Also investigated were the relationships between life satisfaction
and the subject's perceived health status, and attribute variables
of age, gender, education, income, and marital status. The
subjects were 75 non-institutionalized elderly between the
ages of 50 and 90. Three self-report instruments were used
for measurement of the variables: a revised Role Checklist,
a Life Satisfaction scale, and a personal history questionnaire.
Spearman Rank Order correlation coefficients were computed
to test the hypotheses with a significance level of alpha
= 0.05. Significant and positive correlations were found between
valuation and frequency of performance of nine of the ten
roles. Although the primary hypothesis was not supported,
the data suggest that further investigation into the relationships
between frequency of performance of valued roles and life
satisfaction is warranted.
Watson, M.A. (1990). The impact of role valuation and performance
on life satisfaction in old age. Fort Collins, CO: Colorado
State University. (Master's thesis)
This study examined the relationship between frequency of
performance of valued roles and life satisfaction in old age.
Also investigated were the relationships between life satisfaction
and the subjects' perceived health status, and attribute variables
of age, gender, education, income, and marital status. The
subjects were 75 non-institutionalized elderly between the
ages of 50 and 90. Three self-report instruments were used
for measurement of the variables: a revised Role Checklist,
a Life Satisfaction scale and a personal history questionnaire.
Spearman Rank Order correlation coefficients were computed
to test the hypotheses with a significance level of alpha
= 0.05. Significant and positive correlations were found between
life satisfaction and two variables: the role of Home Maintainer
and the subjects' perception of their health...
Wilcock, A.A. (1999). Reflections on doing, being and becoming.
Australian Occupational Therapy Journal, 46, 1-11.
Occupation, and its relationship with health and well-being,
is very complex. It can be described in many different ways
by the profession within which it is so central that it provides
its name. A simple way to talk about occupation that appears
to appeal to a wide range of people is as a synthesis of doing,
being and becoming. In the present paper I reflect on how
a dynamic balance between doing and being is central to healthy
living and wellness, and how becoming whatever a person, or
a community, is best fitted to become is dependent on both.
Doing is often used as a synonym for occupation within our
profession and is so important that it is impossible to envisage
the world of humans without it. Being encapsulates such notions
as nature and essence, about being true to ourselves, to our
individual capacities and in all that we do. Becoming adds
to the idea of being a sense of future and holds the notions
of transformation and self actualization. It is a concept
that sits well with enabling occupation and with ideas about
human development, growth and potential. Occupational therapists
are in the business of helping people to transform their lives
through enabling them to do and to be and through the process
of becoming. In combination doing, being and becoming are
integral to occupational therapy philosophy, process and outcomes,
and some attention is given as to how we may best utilize
these in self-growth, professional practice, student teaching
and learning, or towards social and global change for healthier
lifestyles.
Wilcock, A.A. (1999). The Doris Sym Memorial Lecture: Developing
a philosophy of occupation for health. The British Journal
of Occupational Therapy, 62, 192-198.
The Third Caledonian Health Lecture, held on 3 March 1999,
was dedicated to the memory of Doris Sym, MBE, Fellow of Glasgow
Caledonian University, and founder and first Principal of
the Glasgow School of Occupational Therapy. Professor Gordon
Dickson, Dean of the Faculty of Health at Glasgow Caledonian
University, hosted the event, which was attended by a wide
range of people including Doris's family, friends, ex-colleagues,
practising occupational therapists, retired occupational therapists
and academics from other disciplines within the Faculty of
Health. In 1997, the year of the diamond jubilee of occupational
therapy education in Scotland, I had the honour of presenting
Doris Sym for the award of honorary fellow of Glasgow Caledonian
University. resplendent in her academic robes, Doris gave
a feisty speech recalling the challenges involved in setting
up a new educational establishment and looking forward to
her future participation in University events. Her death early
in 1998 came as a shock to us all. The University was pleased
and honoured to welcome Dr. Ann Wilcock, founding editor of
the Journal of Occupational Science: Australia and historian
of the College of Occupational Therapists, to give her lecture
- 'Developing a philosophy of occupation for health' -- in
memory of a pioneer and visionary woman who led the development
of her profession and established the school teaching it in
the West of Scotland. Ann Carnduff, Head, Division of Occupational
Therapy, Glasgow Caledonian University
Wilcock, A.A. (1999). Creating and shaping the world. Australian
Occupational Therapy Journal, 46, 77-88.
Every day, through their daily occupations, people create
and recreate themselves and shape the world in some way. This
ongoing process is an important factor in maintaining or enhancing
health for individuals and communities, as well as professional
associations. It can also be a major determinant of dysfunction,
disease, disability or death should regular engagement in
occupation not meet the needs of the people or sustain a healthy
environment. In order to illustrate how occupational therapists
can create themselves and shape the world in a positive way,
this paper tells the stories of three women, Octavia Hill,
Elizabeth Casson and Betty McIntyre, who in different ways,
places and times, pioneered our profession. The paper includes
brief discussion about some of the influences on, and the
influence of, these women and about how knowing and reflecting
on their stories can influence our future. In part, this includes
the need for us to understand the depth and strength of our
heritage and the power of taking a proactive stance towards
increasing sociopolitical awareness of occupational therapists'
distinctive and often unappreciated view of the relationship
between occupation and health.
Yerxa E.J. (1998). Health and the human spirit for occupation.
The American Journal of Occupational Therapy, 52, 412-418.
Burke J.P. Clinical interpretation of "health and the
human spirit for occupation". . The American Journal
of Occupational Therapy, 52, 419-422.
The relationship between engagement in occupation and healthfulness
is explored. Health is viewed not as the absence of organ
pathology, but as possession of a repertoire of skills that
enables people to achieve their vital goals in their own environments.
This sort of health, reflecting adaptability and a good quality
of life, is possible for all people, including those with
chronic impairments. Theoretical and research literature from
an array of disciplines explores the influences of occupation
on various aspects of health. These include interests, satisfaction
in everyday doing, balance, the latent consequences of work,
and transcendence. Support is provided for a relationship
between activity level and survival. To improve the life opportunities
of those they serve, occupational therapists need to become
ardent students of life's daily activities, grappling with
the ambiguity and complexity of occupation, the occupational
human, and the contexts in which occupation takes place.
Yerxa, E.J. & Locker, S.B. (1990). Quality of time use
by adults with spinal cord injuries. The American Journal
of Occupational Therapy, 44, 318-326.
The self-perceived quality of time use of 15 community-based
adults with spinal cord injuries was compared with that of
12 age- and sex-matched non-disabled adults through the use
of the Activity Configuration Log (modified from an unpublished
clinical assessment developed by Claudia Allen). Differences
in how subjects classified their daily occupations were found
between and within groups, especially for the categories of
Work, Self-Maintenance, and Other. The results suggest that
the subjects' classifications of occupations and interpretations
of their meanings are important sources of information for
both the science of occupation and occupational therapy practice.
The subjects with spinal cord injuries had a high rate of
unemployment (67%) and much more daily free time than did
their non-disabled counterparts. The affective quality of
particular occupations was found to be related to the affective
quality of the entire day. Occupational therapists agreed
more with each other than with the subjects with disabilities
when classifying occupations. Implications for practice and
research are provided.
Zautra, A.J., Hamilton, N., & Yocum, D. (2000). Patterns
of positive social engagement among women with rheumatoid
arthritis. The Occupational Therapy Journal of Research, 20,
21S-40S.
This article examines the role of positive events in older
women's adaptation to rheumatoid arthritis. In one study,
women with rheumatoid arthritis were compared with healthy
older women. The women with rheumatoid arthritis showed a
less-active pattern of social engagement than the healthy
women, and less-stable patterns over time. In a second study,
women with rheumatoid arthritis participated in an intervention
designed to enhance active patterns of social engagement.
The intervention succeeded in increasing positive social-engagement
patterns. Improvements in quality of life and reduction in
disease activity coincided with these changes. Most improvements
in well-being did not last, but the women's beliefs in their
capacity to cope with their illness were enhanced, and those
beliefs remained significantly higher than levels before the
intervention.
Compiled by Mary
Binderman, MSLS, American Occupational Therapy
Foundation, Bethesda, MD.
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