There is limited information about why students decide to study occupational therapy as a course in Australian higher education. Understanding what influences students' decisions is important to ensure adequate workforce growth to support Australia's growing population. Therefore, the study's aim was to identify what influences students' decisions to study occupational therapy at a regional Australian university, as well as potential facilitators and barriers affecting these decisions. An explanatory mixed methods design was used. One hundred and thirty-four student participants completed an online survey through purposeful sampling, and a convenience sample of 13 survey participants completed follow-up semi-structured interviews. Descriptive statistics were used to analyse survey data, and reflexive thematic analysis was used to analyse the interview data. Consumers and community members were not involved in the development or undertaking of this research. Occupational therapy aligned with students' values, skills, and roles, which influenced their decision to study the profession. These influences included making a positive impact on people's lives (83.2%) and a desire to work in health care (77.1%). Financial supports facilitated their decision to study occupational therapy through family, flexible employment, and government supports. Students primarily heard about the profession through family (30.6%) or friends (18.7%), with their decision heavily influenced by personal connections affording positive exposure to the profession. Narrow societal knowledge and perception of occupational therapy resulted in students gaining a limited understanding of the broad scope and role of the profession. The key findings showed the influence of personal networks in course decision-making, in addition to a narrow societal knowledge and perception of occupational therapy. This finding suggests the need for greater opportunity for diverse exposure to the occupational therapy profession, with more information provided to prospective students about the scope of occupational therapy practice. Occupational therapists are an important part of the Australian health‐care system. However, there is a shortage of occupational therapy workers in Australia, and people are having to wait a long time to see a therapist. To recruit and train new occupational therapists, we need to understand why people decide to study occupational therapy and what supports them or holds them back from making this decision. In this study, 134 occupational therapy students from a regional Australian university completed an online survey, and 13 of these students were interviewed. Both the survey and interviews asked questions about the things that helped students to make their decision to study occupational therapy and the things that supported or held them back in the decision‐making process. The results showed that students' decisions were strongly affected by knowing an occupational therapist, who gave them a positive sense of the profession. Students found the profession matched their values, skills, and roles and knew they could grow within the profession. Financial help allowed students to make their decision to enrol. However, the lack of understanding of what occupational therapists do and the areas in which they work affected the amount of information and understanding students had of the role and scope of the profession. We need more people, including those thinking of studying occupational therapy, to be aware of what occupational therapists do and the many areas that occupational therapists can work.
BackgroundOccupational therapy education in Canada must remain responsive to the complex, intersectional realities and identities shaping learners' experiences and the populations they serve.PurposeThis qualitative study examined how current students (five participants) and recent graduates (three participants) from a Master of Occupational Therapy at The University of British Columbia understood, experienced, and applied intersectionality theory within personal and pedagogical contexts.MethodSemistructured interviews with eight participants were analysed using interpretive description and reflexive thematic analysis.FindingsFour themes emerged: (1) learning about intersectionality, (2) personal explorations of identity, (3) the value of intersectionality in occupational therapy practice, and (4) re-envisioning intersectionality in occupational therapy education. Findings underscore the importance of knowledge gained through lived experiences, the impact of curriculum design on professional identity development, and the urgent need for experiential and critically reflexive pedagogy.ConclusionThis study contributes to the growing literature on intersectionality in occupational therapy and provides concrete recommendations for curriculum transformation within the context of Canadian occupational therapy programmes.
Adolescents with Duchenne Muscular Dystrophy (DMD) are severely affected in their quality of life and pursuit of independence due to progressive muscle weakness and movement limitations. Gamified occupational therapy (OT) can be used to alleviate these difficulties and enable young patients to become more independent in their activities of daily living. This study aims to analyze the effect of a gamified OT program on adolescents diagnosed with DMD to improve their quality of life, occupational performance, and psychosocial health. Boys aged 13-18 years will be assessed for quality of life, occupational performance, and psychosocial health using the Pediatric Quality of Life Inventory 3.0 Neuromuscular Module, Canadian Occupational Performance Measure, and The Children's Depression Inventory. OT and gamified approaches can provide significant benefits for patients with DMD in improving functional abilities, gaining independence, and improving overall quality of life. These interventions can support patients to become more active in activities of daily living and cope with psychosocial challenges. Furthermore, gamification can increase patients' commitment and motivation to therapy by making the rehabilitation process more fun and engaging. This study aims to make innovative contributions to the rehabilitation methods of adolescents with DMD by evaluating the effectiveness of gamified OT program.Clinical trial registration: ClinicalTrials.Gov NCT06402942.
BackgroundSince the release of the Truth and Reconciliation Commission of Canada's Calls to Action in 2015, many post-secondary programs, including occupational therapy, have increased the integration of Indigenous content in curricula. However, limited research has examined how this influences learners' beliefs and attitudes, making it difficult to assess progress toward reconciliation.PurposeTo better understand the effects of Indigenous curricular content on learners' beliefs and attitudes.MethodA pre-post survey was administered to first-year occupational therapy learners as part of an ongoing program evaluation. This evaluation followed the introduction of 17 h of Indigenous content delivered across five courses.FindingsPost content integration, some learners demonstrated decreased perceived professional responsibility as future health professionals and reduced support for social action and related policies, alongside a small increase in blaming attitudes toward Indigenous Peoples. No statistically significant changes were observed in causal beliefs. Learners with higher blaming attitudes were less likely to endorse support for social action or feel responsibility to enact change.ImplicationsBy sharing this evaluation, we aim to foster dialogue among programs regarding successes, challenges, and resource needs, identify strengths and areas for improvement, and underscore the importance of ongoing critical evaluation given the potential for unintended backfire effects.
This study aimed to analyze and optimize therapeutic interventions (according to KTL codes) in post-acute rehabilitation of patients following hip or knee total arthroplasty (TEP). While evidence exists for the effectiveness of individual measures, data on optimal therapy pathways in three-week inpatient TEP rehabilitation setting are lacking. A retrospective secondary use of clinical data was performed using anonymized patient data from 38 (hip TEP) and 29 (knee TEP) orthopedic MEDIAN clinics. A total of 11,628 hip TEP and 7,865 knee TEP patients (data collection: 2016-2019) were included. Based on the validated Staffelstein Score at admission, patients were classified into three groups (low, medium, high baseline value) using k-means clustering. Therapeutic interventions documented via KTL codes were clustered into 14 therapy pathways. Their effectiveness was assessed by the proportion of patients reaching a defined discharge score target in the Staffelstein Score. Optimized therapy modules were derived and compared with the rehabilitation standards (RTS) of the German Pension Insurance. Significant differences in therapy outcomes were observed depending on group and therapy pathway. Patients with high baseline values particularly benefited from strength-based individual therapy (KTL A652) and electrotherapy (KTL K592). Patients with medium baseline values performers achieved best results with group-based physiotherapy (KTL B563), and - among hip TEP patients - with additional manual lymphatic drainage (KTL K672). Patients with low baseline values showed distinct needs: knee TEP patients responded well to coordination training (KTL A580) and assistive device-related occupational therapy (KTL E709), whereas hip TEP patients benefited most from endurance training (KTL A552) and motor-function-focused occupational therapy (KTL E653). Therapy success rates reached up to 97% depending on the appropriate therapy pathway. The study demonstrates that individualized rehabilitation strategies based on functional baseline status lead to significantly better outcomes. The identified therapy pathways provide an evidence-based foundation for refining rehabilitation standards. Prospective validation is recommended to ensure efficient, targeted post-TEP care and to avoid ineffective interventions. Ziel dieser Studie ist die evidenzbasierte Analyse und Optimierung therapeutischer Leistungen (gemäß der KTL) in der Anschlussrehabilitation von Patienten mit Hüft- oder Knie-Totalendoprothesen (TEP). Trotz vorhandener Evidenz zu Einzelmaßnahmen fehlen Daten zu optimalen Therapiepfaden in der dreiwöchigen stationären TEP-Reha.In einer retrospektiven Sekundärnutzung von Behandlungsdaten wurden anonymisierte Daten aus 38 (Hüft-TEP) bzw. 29 (Knie-TEP) orthopädischen MEDIAN-Kliniken ausgewertet. Berücksichtigt wurden insgesamt 11 628 Hüft-TEP- und 7 865 Knie-TEP-Patienten (Erhebungszeitraum 2016–2019). Anhand des validierten Staffelstein-Scores bei Aufnahme wurden die Patienten mittels k-Means-Clusteranalyse in drei Gruppen (Niedriger, Mittlerer und Hoher Eingangswert) unterteilt. Die KTL-dokumentierten Therapieleistungen wurden in 14 Therapiepfade geclustert und deren Wirksamkeit anhand des Erreichens eines festgelegten Entlassziels im Staffelstein-Score bewertet. Optimierte Therapieblöcke wurden abgeleitet und mit den Reha-Therapiestandards (RTS) der Deutschen Rentenversicherung abgeglichen.Die Analyse zeigte deutliche Unterschiede im Therapieerfolg je nach Eingangswert-Gruppe und Therapiepfad. Patienten mit Hohem Eingangswert profitierten insbesondere von kraftorientierter Einzeltherapie (KTL A652) und Elektrotherapie (KTL K592). Patienten mit Mittlerem Eingangswert erreichten mit Gruppentherapieansätzen (KTL B563) und – bei Hüft-TEP – ergänzender manueller Lymphdrainage (KTL K672) die besten Ergebnisse. Bei Patienten mit Niedrigem Eingangswert zeigten sich gruppenspezifische Bedarfe: Knie-TEP-Patienten profitierten von Koordinationstraining (KTL A580) und hilfsmittelbezogener Ergotherapie (KTL E709), während Hüft-TEP-Patienten von Ausdauertraining (KTL A552) und motorisch-funktioneller Ergotherapie (KTL E653) besonders profitierten. Insgesamt zeigte sich eine Erfolgswahrscheinlichkeit von bis zu 97% je nach passendem Therapiepfad.Die Studie zeigt, dass individualisierte Rehabilitationsstrategien unter Berücksichtigung des funktionellen Ausgangsniveaus zu deutlich besseren Therapieergebnissen führen. Die identifizierten Pfade bieten eine erste evidenzbasierte Grundlage zur Weiterentwicklung der Reha-Therapiestandards. Künftig sollte eine prospektive Validierung dieser Pfade erfolgen, um eine differenzierte, effektive Versorgung nach Hüft- und Knie-TEP sicherzustellen und ineffiziente Maßnahmen zu vermeiden.
The purpose of this study was to measure the change in interprofessional competency of physician assistant (PA) students through observation of occupational therapy (OT) and physical therapy (PT) in a university, student-run pro bono therapy clinic. The study aimed to expand knowledge of rehabilitation interventions to PA students for improved collaborative practice. Using a retrospective pretest-posttest design, 75 PA students observed an OT or PT treatment session at a student-run pro bono clinic. The modified Interprofessional Collaborative Competency Attainment Survey measured self-perceived skills across 6 competency domains. It asked participants to reflect on their competencies before and then after the observation. Open-ended survey questions were used to identify qualitative themes regarding the learning experience. Mean total competency scores increased significantly from 3.73 (SD 0.94) before the observation to 4.31 (SD 0.65), P < .001. Significant increases were found across all 6 subscales (P < .001). Qualitative analysis identified 5 themes: knowledge of colleagues, collaboration maximizing care, recognizing when to refer, active listening, and functional training provided by OT and PT. Results suggest the observation broadened student understanding of interprofessional roles and enhanced confidence in collaborative teamwork. Students experienced a meaningful shift in awareness regarding OT and PT scopes of practice. They expressed enhanced understanding of patient-centered care that incorporates functional goals. This knowledge change highlighted the value of interprofessional educational experiences to foster collaborative care.
Life, occupational, and work-life balance are essential factors influencing health, well-being, and quality of life. Although these concepts are frequently discussed, their definitions remain inconsistent, and research based on interventions is limited. This study aims to identify interventions that promote life, occupational, or work-life balance and to explore how these concepts are understood within intervention studies. A scoping review was conducted using the Joanna Briggs Institute framework and PRISMA-ScR guidelines. Eighteen studies met the inclusion criteria. Participants in the included studies were adults, health care workers, individuals with mental health conditions, and students. Interventions focused on time use, mindfulness, gratitude/happiness training, behavior change, and storytelling. Findings indicate diverse intervention approaches are used to promote balance and well-being. However, variability in how life, occupational, and work-life balance are described and measured highlights the need for greater conceptual clarity. A Review of Interventions That Promote Life, Occupational, and Work–Life BalanceBalancing work, school, family responsibilities, and personal time can be challenging. When people feel that their daily activities are out of balance, they may experience stress, burnout, and a decline in well-being. Certain groups and populations might be more prone to imbalance in these areas. Occupational science explains how individuals engage in meaningful daily activities, making it crucial to understand how to promote a healthy balance in everyday life in occupational therapy. This review identified interventions focused on life, occupation, and work–life balance. The included studies encompassed published research from around the world testing programs or strategies designed to improve work–life balance, occupational harmony, or work–life balance. Eighteen studies met the inclusion criteria. Most of these studies involved adults without specific medical conditions, though some focused on groups such as health care workers, people with mental health issues, students, teachers, and those recovering from COVID-19. The programs in these studies employed various approaches. Some helped individuals better manage their time and plan daily routines. Others used mindfulness training to reduce stress and increase awareness of daily habits. Additional programs emphasized gratitude and happiness exercises, behavior change strategies, and group discussions or storytelling to encourage reflection on daily activities and priorities. A variety of strategies may enhance a sense of balance and well-being. However, researchers use different definitions and measurements for life, occupation, and work–life balance. More research is necessary to better define these concepts and to develop clear, effective interventions that occupational scientists and therapists can utilize to help people establish healthier, more sustainable daily routines.
Background: International fieldwork placements (IFPs) may cultivate personal and professional competencies within healthcare education. Limited research explores how IFPs shape the development of Canadian occupational therapists in the early stages of their careers. Purpose: To explore how Canadian occupational therapists make sense of their IFP experience in relation to their transition from student to practitioner and their current professional practice. Method: Data were collected through semi-structured individual interviews which sought to encourage reflection and dialogue about participants' IFP experiences, post-graduation transitions, and lasting impacts. Interpretative phenomenological analysis (IPA) was used to co-construct meaning from participants' narratives and identify convergent and divergent experiences. Findings: Eight participants completed IFPs in partnership with low-income countries; one completed the placement virtually. Four key themes were identified: Self-Efficacy, Resourcefulness, Relational Growth, and Cultural Responsiveness. These themes reflect participants' engagement with complex intercultural contexts, personal and professional growth, and critical reflection on their evolving identities as occupational therapists. Conclusion: Our study provides insight into how IFPs influence occupational therapists, particularly in shaping professional identity and informing culturally responsive practices. Findings highlight the value of IFPs in occupational therapy education and may inform curriculum design, student selection, and strategies to improve accessibility.
Organic fluoride compounds are a class of chemical raw materials containing fluorocarbon bonds, primarily classified into fluorinated alkanes and fluorinated olefins. Short-term high-concentration inhalation can lead to acute lung injury, acute respiratory distress syndrome (ARDS), and rapidly progressive pulmonary fibrosis, with persistently high clinical mortality rates. This study summarizes the clinical characteristics, treatment experience, and prognostic factors of acute occupational inhalation poisoning by mixed organic fluoride gases to provide reference for similar case management. A retrospective analysis was conducted on the occupational exposure history, clinical diagnosis and treatment process, and outcome data of a patient who inhaled a mixture of hexafluoropropylene and tetrafluoroethylene in a sealed, non-ventilated warehouse. The patient developed irritative dry cough and progressive dyspnea after toxin exposure. Despite symptomatic supportive treatment at another hospital, the condition continued to deteriorate, leading to admission to our hospital on 9 days post-exposure. Upon admission, the oxygenation index was 123.1 mmHg, and chest CT revealed diffuse reticular and honeycomb-like density enhancement in both lungs, confirming a diagnosis of acute severe organic fluoride poisoning with moderate ARDS. Comprehensive interventions including high-dose glucocorticoid pulse therapy, invasive mechanical ventilation, anti-infection measures, alveolar lavage, and veno-venous extracorporeal membrane oxygenation (VV-ECMO) were administered, yet the patient's condition continued to worsen. The patient ultimately died from respiratory and circulatory failure due to severe pulmonary fibrosis complicated by spontaneous pneumothorax. Acute organic fluoride poisoning has a poor prognosis, necessitating emphasis on early identification, adequate and prolonged corticosteroid therapy, and prompt initiation of ECMO support. Concurrently, occupational safety and health education in workplaces should be strengthened to reduce disease risk at the source. 有机氟化合物为含氟碳键的一类化工原料，主要分为氟烷烃、氟烯烃两类，短时间高浓度吸入可致急性肺损伤、急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS）及快速进展性肺纤维化，临床病死率居高不下。总结急性职业性混合有机氟气体吸入中毒的临床特征、救治经验及预后影响因素，为同类病例诊疗提供参考。回顾性分析1例于密闭无通风仓库内吸入六氟丙烯、四氟乙烯混合气体的急性中毒患者的职业接触史、临床诊疗过程及转归资料。患者毒物接触后出现刺激性干咳、进行性呼吸困难，外院对症支持治疗后病情持续进展，于暴露后9 d转入我院；入院时氧合指数123.1 mmHg，胸部CT提示双肺弥漫性网格状、蜂窝状密度增高影，确诊为急性重度有机氟中毒、中度ARDS；予大剂量糖皮质激素冲击、有创机械通气、抗感染、肺泡灌洗及静脉-静脉体外膜肺氧合（VV-ECMO）等综合救治，病情仍进行性恶化，最终因严重肺纤维化合并自发性气胸致呼吸循环衰竭死亡。急性有机氟中毒预后差，需强调早期识别、足量足疗程糖皮质激素应用、及时启动ECMO支持的救治策略，同时应强化作业场所职业防护宣教，从源头降低发病风险。.
Chronic occupational exposure to contaminated aquatic environments is an underrecognized cause of progressive lung injury. Recurrent aspiration of sediment-rich river water can lead to chronic inflammatory lung injury with possible environmental pathogen colonization and destructive lung disease, even in immunocompetent individuals. A 35-year-old non-smoking professional diver in a tropical mangrove region of the Sundarban, Bangladesh, with 17 years of exposure performing 10-15 daily dives in muddy saline mangrove water, presented with 1 year of progressive exertional dyspnea and intermittent cough. Water aspiration during mud collection was frequent; four coworkers reported similar symptoms. SpO2 was 93% at rest, dropping to 89% after 700 m on a 6-min walk test, indicating exercise-induced desaturation despite preserved walking distance. Digital clubbing and bilateral coarse crepitations were present. HRCT showed diffuse nodules and a left upper lobe cavitary lesion; Mantoux and Interferon gamma release assay were negative. Pulmonary function revealed severe restrictive defect (TLC 39%, FVC 25%, DLCO 36%, RV/TLC 48%). BAL grew Acinetobacter sensitive to meropenem and amikacin. After 7 days of IV therapy, symptoms improved, but domiciliary oxygen was not feasible. The patient died 1 month later. Muddy water pneumonitis can cause progressive necrotizing lung injury in divers, likely representing a multifactorial process involving environmental particulate exposure with superimposed infection. It was worsened by socioeconomic constraints and highlights the need for occupational protection and early recognition.
The rate of population ageing is increasing far more quickly than in the past, making active ageing a critical focus. Occupational activities are the daily tasks performed by individuals and are closely related to well-being. Research on sociodemographic factors associated with the time spent in occupational activities by older persons in Malaysia is limited. Understanding these patterns can help policymakers and healthcare providers tailor interventions to support different demographic groups among older persons. The occupational activities examined in this study were personal care, employment-related, education, domestic, childcare, purchasing, voluntary, social, and leisure activities. The objective of this study was to identify the differences in the time spent by older persons in occupational activities based on sociodemographic factors. A cross-sectional study involving 270 older persons from activity centres for older persons in Klang Valley was conducted using the Modified Occupational Questionnaire-Malay version and analysed using Mann-Whitney U test and Kruskal-Wallis test. Findings show significant differences in time spent on domestic activities based on employment status (P = 0.046), employment-related activities based on type of housing and household size (P = 0.034; P = 0.047), and leisure activities based on household size (P = 0.006), while social activities differed based on gender (P = 0.038) were observed. Working older persons engaged more in domestic activities than non-working older persons; women engaged more frequently in social activities than men. A significant difference was also found in the time spent on employment-related activities between living in high-end and affordable housing. Tailoring interventions based on these factors is crucial for promoting active ageing and enhancing the well-being of older persons.
The primary aim was to assess the feasibility of a home-based occupational positioning program for children with spastic cerebral palsy (SCP), focusing on compliance, dosage, and satisfaction. A secondary aim was to explore its preliminary effectiveness on self-care, mobility, social function, gross motor function, and goal attainment. This single-group feasibility study, conducted prior to a larger RCT, included five children aged 3.5-6 years with SCP (GMFCS III-IV) without severe intellectual disability, and aimed at assessing feasibility while exploring preliminary effects. The home-based occupational positioning program involved general and customized booklet-based training, two in-home sessions using Goal Attainment Scaling (GAS) to establish the home program, and 12 weekly remote sessions. Feasibility outcomes were assessed by compliance, dosage, and satisfaction, while preliminary effectiveness was evaluated using the PEDI (self-care, mobility, and social function), Gross Motor Function Measure (GMFM-88), and GAS. All participants completed the study without adverse events or attrition. Mean compliance was 96.4% ± 4.93%, average satisfaction was 9.8 ± 0.44 on a 10-point scale, and the average daily program time was 5.35 ± 3.11 h. Significant improvements (p < 0.05) were observed by Wilcoxon signed-rank test in self-care, mobility, and social function, as well as in GMFM-88 and GAS scores. The home-based occupational positioning program showed high feasibility, likely supported by family engagement, collaborative goal setting, real-life implementation, caregiver education, and consistent remote support. Preliminary findings suggested potential benefits for self-care, mobility, social function, gross motor function, and goal attainment. Iranian Registry of Clinical Trials: IRCT20231012059697N1.
Motion-assisted multi-modal memory desensitization and reconsolidation (3MDR) has emerged as a promising advancement in exposure-based therapies, particularly for treatment-resistant posttraumatic stress disorder (PTSD) and related disorders. Integrating treadmill-assisted movement with personalized trauma-related imagery and guided narrative processing, 3MDR promotes emotional engagement and supports memory reconsolidation in ways that traditional therapies often fail to achieve. This article reviews key developments in 3MDR's evolution, validation, and implementation. Randomized controlled trials in the Netherlands, the United Kingdom, the United States, and Canada have demonstrated significant reductions in PTSD symptoms, improved emotional processing, and strong patient adherence. Originating from the Computer-Assisted Rehabilitation Environment system - initially designed for physical rehabilitation - 3MDR was adapted to overcome avoidance and disengagement frequently seen in Veterans and other trauma-exposed groups. Technological improvements, including enhanced software usability, high-definition immersive visuals, and real-time customization, have strengthened its therapeutic impact. Recent expansions include pilot applications for adolescents, moral injury, and complex PTSD, supported by a structured international training framework requiring supervised cases and ongoing coaching through the International Consortium of 3MDR. Emerging innovations, such as HoloLens-based delivery, are also being explored. While acceptance among patients and clinicians is strong, broader adoption will require sustained investment in infrastructure and workforce training. Motion-assisted multi-modal memory desensitization and reconsolidation (3MDR) is an innovative therapy integrating movement, memory, and immersive virtual reality to treat posttraumatic stress disorder (PTSD), particularly in treatment-resistant cases. Originally developed within physical rehabilitation technology, 3MDR has evolved into a globally recognized trauma therapy. By combining treadmill-assisted movement with personalized trauma-related imagery and narrative processing, 3MDR fosters deep emotional engagement and memory reconsolidation. International research, including randomized controlled trials in the Netherlands, the United States, the United Kingdom, and Canada, supports 3MDR’s efficacy. These trials demonstrate significant reductions in PTSD symptoms, increased patient engagement, and long-term therapeutic benefits. Technological advancements, such as head-mounted display integration and software refinements, further enhance its accessibility and usability. As 3MDR transitions from clinical trials to widespread implementation, clinician training and infrastructure investment will be essential to scaling its impact. This paper explores 3MDR’s journey from its origins to its current role as a transformative PTSD intervention and its potential for broader adoption. La thérapie multimodale de désensibilisation et de retraitement de la mémoire assistée par le mouvement (DRMM) est une percée prometteuse des thérapies d’exposition, notamment dans les cas de trouble de stress post-traumatique (TSPT) et des troubles connexes. Intégrant le mouvement sur tapis roulant à l’imagerie personnalisée liée au traumatisme et au processus de narration guidé, la DRMM favorise un engagement émotionnel et une reconsolidation de la mémoire que, souvent, les thérapies habituelles ne parviennent pas à obtenir. Cet article examine les principaux éléments de l’évolution, de la validation et de la mise en oeuvre de la DRMM. Des études randomisées et contrôlées des Pays-Bas, du Royaume-Uni, des États-Unis et du Canada ont démontré des réductions importantes des symptômes de TSPT, ont amélioré le traitement émotionnel et favorisé une forte adhésion des patient.e.s. Issu du système de réadaptation assisté par ordinateur, d’abord conçu pour la réadaptation physique, la DRMM a été adaptée pour vaincre l’évitement et le désengagement souvent observés chez les vétéran.e.s et d’autres groupes exposés aux traumatismes. Les améliorations technologiques, y compris l’ergonomie logicielle améliorée, les visuels immersifs à haute résolution et la personnalisation en temps réel, en ont renforcé les répercussions thérapeutiques. Les récents élargissements incluent les applications pilotes pour les adolescents, les blessures morales et les TSPT complexes, soutenus par un cadre de formation internationale structuré qui exige des cas supervisés et un encadrement continu par l’entremise du consortium international de DRMM. Des innovations émergentes, comme la prestation fondée sur le casque HoloLens, sont également explorées. Les patient.e.s et des clinicien.ne.s acceptent largement cette thérapie, mais pour parvenir à une adoption plus vaste, il faudra des investissements soutenus dans l’infrastructure et la formation de la main-d’oeuvre.
ObjectiveTo evaluate the effects of a 4-week intensive, goal-oriented muscle strengthening program on functional goal attainment, physical performance, fatigue, and self-esteem in ambulatory adults with cerebral palsy (CP).DesignRetrospective monocentric uncontrolled observational study.ParticipantsSixty-six ambulatory adults with hemiplegic, diplegic or quadriplegic CP, classified as Gross Motor Function Classification System (GMFCS) levels I-III.MethodsThe intervention consisted in a 4-week intensive group program (48 h total) focused on individualized, goal-directed muscle strengthening. Functional goals were assessed with the Canadian Occupational Performance Measure. Physical performance included the 6-Minute Walk Test, Gross Motor Function Measure, and muscle strength testing. Fatigue was measured using the Fatigue Impact Scale, and self-esteem with the Rosenberg Self-Esteem Scale.ResultsMost goals concerned mobility (32%), domestic activities (25%), and leisure (19%). Significant improvements were observed in COPM performance (+1.8) and satisfaction (+2.4), walking distance (+49.4 m), GMFM dimensions D and E (+2.9 and +3), and muscle strength (all p<0.001). Fatigue decreased across all FIS domains, and self-esteem improved modestly. No correlation was found between fatigue reduction and motor gains.ConclusionThis first study of intensive group therapy in adults with CP shows that participation in the program was associated in improvements in short-term functional outcomes without increasing fatigue, aligns with patient priorities, and may support active and healthy aging. These findings should be interpreted with caution due to the study design.
This article documents and discusses the life and work of Meta Rupp Cobb, first executive secretary paid by the American Occupational Therapy Association (AOTA) when the office was in New York City. Cobb took office during the period when the American economy was recovering from the Great Depression and World War II was on the horizon, complicating Cobb's position as the primary spokesperson and contact person representing the profession of occupational therapy in the United States (U.S.) and abroad. This paper discusses Cobb's contributions to the AOTA and the profession in the three areas: national office and staff, national association activities, and nationwide response to the need to increase manpower, educational opportunity and delivery of occupational therapy services. The methodology was qualitative using historical documents from the late 1930s and early 1940s based on biographical research. This paper provides an important examination of one of the most significant positions in the AOTA as well as Cobb's contributions to the profession but may be overlooked historically because of the impact of World War II on occupational therapy personnel and services.
Musculoskeletal pain is a major concern for agricultural workers worldwide. However, access to safe and non-opioid pain relief measures is limited in resource-scarce settings. Hemp flower oil, a rich source of cannabinoids and terpenes, has been recognised as a promising adjunct pain therapy due to its analgesic and anti-inflammatory activities through the activation of CB2 receptors, TRP channels, cytokine downregulation and antioxidant mechanisms. This study is a systematic scoping review with narrative synthesis conducted in accordance with PRISMA 2020 guidelines which aims at addressing this issue through a comprehensive analysis of available evidence using a phytochemical, mechanistic, genomic and sustainability approach. This review is guided by the PRISMA framework and incorporates a total of n = 44 studies conducted between 2000 and 2025. Preclinical research accounted for a significant proportion of the overall evidence (68%), indicating a strong mechanistic rationale for hemp flower oil as a pain reliever. Clinical trials accounted for a small proportion of the overall evidence (23%), while genomic research accounted for a small proportion of the overall evidence (9%), indicating associations between cytokine polymorphisms and ion channel variants and cannabinoid receptor genotypes. This review aims to bridge the gaps and address the knowledge gaps and research priorities through a comprehensive analysis of available evidence and a roadmap for future research using a novel interdisciplinary approach. Hemp flower oil shows preliminary potential, but current clinical evidence remains limited and of low certainty for managing musculoskeletal pain in agricultural workers.
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Nocardiosis is an opportunistic infection caused by aerobic, Gram-positive actinomycetes of the genus Nocardia that most often affects patients with impaired cell-mediated immunity, including those receiving corticosteroids or other immunosuppressive therapies. Disseminated disease frequently involves the central nervous system, where a systematic review reported an overall case fatality rate of 22.8%, and Nocardia farcinica is the most commonly identified species. We report a case of disseminated Nocardia farcinica with multiple cerebral abscesses in a patient receiving induction immunosuppressive therapy for autoimmune hepatitis. A 55-year-old man with a history of autoimmune hepatitis and occupational soil exposure presented with 4-5 week history of progressive cognitive impairment, dysarthria, and right upper extremity weakness. Two months earlier, he had been treated with high-dose corticosteroids and azathioprine and prescribed trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis, which had been interrupted for an estimated 2-4 weeks before presentation during ongoing corticosteroid therapy. Upon admission, laboratory tests demonstrated neutrophil-predominant leukocytosis with lymphopenia, and liver function tests showed substantial improvement compared to his initial presentation of autoimmune hepatitis. Neuroimaging revealed multiple ring-enhancing intracerebral lesions with surrounding vasogenic edema. Stereotactic aspiration of a cerebral abscess and drainage of a concurrent retroperitoneal collection grew Nocardia farcinica, confirming disseminated nocardiosis. Antimicrobial therapy was transitioned to imipenem-cilastatin and TMP-SMX based on susceptibility testing. During infection management, azathioprine was paused, and prednisone was continued at a dose of 25 mg/day, followed by a biochemical autoimmune hepatitis flare requiring hepatology-guided monitoring. The patient demonstrated gradual neurologic improvement and was discharged to inpatient rehabilitation after an 18-day hospitalization. Disseminated nocardiosis should be considered for immunosuppressed patients with autoimmune hepatitis presenting with subacute neurological decline and ring-enhancing brain lesions, particularly during outpatient immunosuppression transitions when antimicrobial prophylaxis may be interrupted or incompletely reconciled. The patient demonstrated progressive neurological improvement and radiographic abscess reduction after 3 months of susceptibility-guided combination therapy, reinforcing the importance of early tissue diagnosis and neurosurgical intervention in this population.
Guidelines support early mobilization in the pediatric intensive care unit (PICU). In our 75-bed PICU, we implemented "PICU Move!," a standardized early mobilization protocol using "Critical Care Illness Levels" (CCILs) that specify mobilization goals based on patients' medical status. We used systems-based interventions (electronic health record order sets and workflows, opt-out therapy consultations, and progressive mobilization equipment) and person-based interventions (education, mobility champions, simulations, and mobility rounds). Process measures were CCIL ordering compliance, early mobilization goal compliance, and the proportion of admissions with a length of stay (LOS) ≥ 72 hours that included consultations with physical therapy (PT) and occupational therapy (OT). Outcome measures included time to first registered nurse activity documentation (all admissions and admissions with LOS ≥72 h) and admissions with LOS ≥72 hours with multiple PT/OT contacts. Balancing measures included safety event reports related to early mobilization activities, unplanned extubations, and falls. During the intervention period (July 2023-December 2024), median monthly CCIL compliance was 95.9%, and early mobilization goal compliance was 49.4%. Compared to baseline, the average monthly proportion of admissions with LOS ≥72 hours with PT or OT consultation increased from 38.8% to 82.6% and from 34.3% to 81.2%, respectively. Multiple PT and OT contacts increased from 40.9% to 81.7% and from 37.7% to 70.8%, respectively. Time to first activity decreased from 21.6 to 19.6 hours (all admissions) and from 67.9 to 59.1 hours (admissions with LOS ≥72 h). There were no documented safety events related to early mobilization activities. In a large PICU, systems-based interventions, supplemented by person-based interventions, safely reduced time to first activity and increased the number of repeated PT/OT contacts.
To explore barriers and facilitators to implementing the ROWTATE vocational rehabilitation intervention and identify lessons for future service delivery. Qualitative interview implementation study embedded within the development and evaluation of a complex health intervention, guided by the UK Medical Research Council framework. National Health Service (NHS) major trauma services in England. The ROWTATE intervention included early vocational assessment lasting up to 12 months, case management, employer engagement and coordinated multidisciplinary support between occupational therapists and clinical psychologists. The intervention was delivered via hybrid models following COVID-19 adaptations. Purposively sampled stakeholders including patients, therapists, mentors, employers, carers, commissioners and primary care practitioners. 80 semistructured interviews were conducted remotely between March 2023 and June 2025 using topic guides informed by the Consolidated Framework for Implementation Research and the Theoretical Framework of Acceptability. Data were analysed using framework coding followed by reflexive thematic analysis to generate cross-cutting themes and implementation-focused recommendations. Implementation was shaped by six cross-cutting themes that acted as both barriers and facilitators depending on context. Stakeholders highlighted the importance of addressing diverse patient needs and outcomes through early, personalised support and case management. Remote delivery improved accessibility and flexibility but was most effective when combined with face-to-face contact to strengthen relationships and contextual understanding. Multidisciplinary occupational therapy and clinical psychology collaboration enabled holistic care, though required structured processes to overcome communication challenges. Mentoring provided essential professional development and mitigated isolation in remote roles, while employer engagement facilitated workplace adjustments and retention but was constrained by patients' reluctance to involve employers and by variable occupational health provision. Strategic buy-in from commissioners and clinical leaders was critical, with emphasis on robust outcome data and economic evidence to support sustainability. Findings inform strategies for embedding vocational rehabilitation within integrated care models and identify core components that should be protected to support implementation when scaling hybrid delivery (eg, mentoring and structured multidisciplinary team processes). The study also outlines scalable approaches to hybrid service delivery, workforce development and employer engagement, offering transferable lessons for health systems seeking to reduce economic inactivity and address post-trauma inequalities. ISRCTN43115471.