Abstract
Abstract
The aim of this scoping review was to identify and describe how occupational adaptation has been used in different research studies published from 1992 to 2015 and to identify possible gaps in study design. Four categories of studies were identified: those focused on understanding how occupational adaptation occurs in different life situations and different health conditions, those focused on the use of occupational adaptation as a guide or model in organizing the occupational therapy process, and those using occupational adaptation as a part of instrument development. Several gaps in research are evident including updating the theory development on occupational adaptation, types of maladaptation, studies conducted in less affluent countries, quantitative studies with robust designs, inclusion of men and younger persons as subjects, vulnerable groups, health promotion, and community settings.
Introduction
Occupational adaptation is a concept of relevance within occupational therapy and research (Kielhofner, 2008; Nelson, 1997; Schultz, 2014) that has been discussed in occupational therapy literature over the past 25 years with various definitions and applications (Reed, 2015).
Schkade and Schultz (1992) are credited with minting the concept occupational adaptation. According to Schultz (1997), occupational adaptation is the individual's response in meeting an occupational challenge. This adaptation is required when the individual's ordinary response is insufficient for mastering his or her occupations. One fundamental assumption is that the person wishes to master the environment and that the environment demands mastery on the part of the person. “Success in occupational performance is a direct result of the person's ability to adapt with sufficient mastery to satisfy the self and others” (Schultz, 2014, p. 528). In addition, occupational adaptation has been referred to as a theory for occupational therapy practice and research (Schkade & Schultz, 2003).
Nelson (1997) explained the concept of occupational adaptation by using basic knowledge of occupation. He argued that it is possible for a person to change his or her own sensorimotor, cognitive and psychosocial abilities by engaging in occupation. Moreover, Nelson and Jepson-Thomas (2003) defined adaptation as “the effect of occupational performance on the individual's developmental structure” (p.119). They argued that adaptation does not always have a salutary effect. Repeated mistakes in occupational performance may entail a “learned sense of helplessness” (p.121) when a person meets future occupational challenges. Nelson and Jepson-Thomas (2003) called this maladaptation.
Somewhat later, Kielhofner (2008) defined occupational adaptation as “constructing a positive occupational identity and achieving occupational competence over time in the context of one's environment” (Kielhofner, 2008, p. 109). He also put forward the idea that occupational development and change have an impact on volition, habituation, and performance capacity, and thus are part of individual development. To stimulate occupational adaptation, the person must maintain occupational identity and occupational competence through engagement in meaningful personal activities. Despite the prevalence of a definition, there is no application in the Model of Human Occupation (MOHO) practice model, but several assessment tools, connected to occupational adaptation within the MOHO (Kielhofner, 2008).
In summary, occupational adaptation has various meanings and explanations according to different scholars. Occupational adaptation is central to the approach suggested by Schkade and Schultz (1992). The concept occupational adaptation refers to the process that begins with the occupational challenge and proceeds to an occupational (adaptive) response that should include mastery. Related key concepts are occupational challenge, adaptive response, and relative mastery. Kielhofner (2008) explains occupational adaptation as something that occurs throughout life but is only one construct among many in MOHO (Kielhofner, 2008). Specifically, the concept occupational adaptation is used to refer to the process of creating and enacting a positive occupational identify and self-identity. Important to note is that Schkade and Schultz provided a specific intervention process but Kielhofner did not. Nelson's explanation of the concept of occupational adaptation is mainly theoretical and has not been applied further (Nayar & Stanley, 2015).
Kielhofner's (2008), Nelson's (1997), and Schultz's (2014) different theoretical explanations of occupational adaptation might provide further understanding of the phenomenon. However, an overview is lacking as to how occupational adaptation has been used in research since it first was introduced by Schkade and Schultz in 1992. Such an overview might facilitate the identification of gaps that could further guide the development of the approaches of occupational adaptation in research as well as in science and practice. Therefore, the aim of this scoping review was to identify and describe how occupational adaptation is used in relation to different research topics in articles published from 1992 to 2015 and to identify possible gaps in study design.
Methods
A scoping review methodology was used in the present study in order to map, summarize, and disseminate knowledge about occupational adaptation and to identify research gaps in the chosen field (Arksey & O'Malley, 2005). Scoping reviews have become common in health research, but there is no consensus on such reviews regarding terminology, definition or methodological steps (O'Brien et al., 2016). However, Colquhoun et al. (2014) recommended the following definition:
Scoping review or scoping study is a form of knowledge synthesis that addresses an exploratory research question aimed at mapping key concepts, types of evidence, and gaps in research related to a defined area or field by systematically searching, selecting, and synthesizing existing knowledge. (p. 1292)
In the present scoping review, the methodology proposed by Arksey and O'Malley (2005) was used and supplemented with recommendations made by Levac, Colquhoun, and O'Brien (2010), as suggested by O'Brien et al. (2016). Thus, the following five steps (Arksey & O'Malley, 2005) were used: 1) identifying the research question and relevant articles, 2) selecting the studies, 3) charting the data, 4) collating the results, and 5) summarizing and reporting the results. The research question was: How has occupational adaptation been used in research articles between 1992 and 2015 and what are the research gaps?
The search process was conducted through the electronic databases of Academic Search Elite, Age Line, AMED, CINAHL, Medline, and PsycInfo. To cover as many approaches as possible, the sole search term was “occupational adaptation.” Peer-reviewed articles published in scientific journals were used, and the inclusion criteria were: written in English, primary research, full text, published during the period 1992–2015, related to occupational therapy theory and/or practice and the term occupational adaptation in the title, abstract, or keywords. As Schkade and Schultz's seminal article about occupational adaptation was published in 1992 with the initial concept of occupational adaptation, this date was chosen as a starting date.
The search procedure ended in December 2015, and 260 references were found. The same references were found in many of the databases, and after excluding duplicates, 135 articles were left. Even though occupational adaptation was a search criterion in the title, abstract or keywords, 59 articles had to be excluded because they did not include occupational adaptation, and thus 76 remained. Having read these articles in full, 31 were excluded for other reasons, such as lack of primary research (n = 5), lack of relevance to the research question (n = 21) (i.e., occupational adaptation was found in keyword or title without any relevance in results or discussion) or article not peer-reviewed (n = 5). Finally, the reference lists of the five literature reviews excluded were checked, as suggested by Arksey and O'Malley (2005), but no further references were identified, and this resulted in 45 articles remaining for the analysis (Figure 1).
Published online:
22 November 2018![]({"type":"image","src":"/na101/home/literatum/publisher/tandf/journals/content/iohc20/2018/iohc20.v032.i04/07380577.2018.1526433/20190422/images/medium/iohc_a_1526433_f0001_b.jpg"})
Figure 1. Search strategy and selection of articles for the scoping review.
The 45 articles were read through in full by the first and last authors. Data were extracted from each article and entered in a “data charting form” (Arksey & O'Malley, 2005) (Table 1). First, descriptive quantitative data such as author names, publication year, national context of the study, aim, study design, sample, and the theoretical approach were extracted and summarized in the charting form. Secondly, the articles were read through several times with the purpose of ascertaining how occupational adaptation was used in relation to different research topics and they were sorted into different categories (see Figure 2).
Published online:
22 November 2018Figure 2. Articles sorted in categories in relation to how occupational adaptation was used in relation to different research topics.
![]({"type":"image","src":"/na101/home/literatum/publisher/tandf/journals/content/iohc20/2018/iohc20.v032.i04/07380577.2018.1526433/20190422/images/medium/iohc_a_1526433_f0002_b.jpg"})
Figure 2. Articles sorted in categories in relation to how occupational adaptation was used in relation to different research topics.
Table 1. Data charting form.
Results
Demographics of studies
Ten countries were represented, predominantly from the United States (n = 19), but also from Australia (n = 7), Canada (n = 7), Sweden (n = 6) and with one from Ireland, Jordan, Netherlands, Switzerland, South Africa, and United Kingdom.
There was a predominance of studies based on qualitative design (n = 33). In most of the studies, in-depth interviews (n = 29) were used, but various kinds of case studies (n = 4) were also identified (Bouteloup & Beltran, 2007; McIntyre & Howie, 2002; Nastasi, 2015; Stelter & Whisner, 2007). Quantitative design was used in nine studies, and of those three were quasi-experimental (Buddenberg & Schkade, 1998; Gibson & Schkade, 1997; Jackson & Schkade, 2001). For further information about the design and national context of the study, see Table 1.
The number of participants in the qualitative studies was generally small and varied from 1 to 35; most of the studies included fewer than 11 participants. The number of participants in the quantitative studies varied from 8 to 144. The results show a skewed demographic sample among the studies included. There were twice as many women as men among the participants in the studies included. Most of the participants were middle-aged or over 65 years, but one study included a case-study with one child (Bouteloup & Beltran, 2007) and another study included teenagers (Pasek & Schkade, 1996).
In some way, the participants' characteristics differed, but a few clear patterns could be seen. The participants in most of the studies were persons with various kinds of disabilities, such as stroke, head injury, multiple sclerosis, hip fractures, and arthrosis. Other common characteristics of participants in the studies included were older persons with dementia, physical disabilities, or poor vision. In addition, there were 10 studies on emerging arenas in occupational therapy, new client groups, and/or clients with occupational problems. For a full list of participant's characteristics in the included articles, see Table 2.
Table 2. An overview of participant's characteristics in and authors of the included articles.
Considering theoretical approach, most of the articles were based on Schkade and Schultz's (1992, 2003) (n = 29) and Kielhofner's (2008) (n = 13) or applied a combination of both (n = 3) (see Table 1).
How occupational adaptation was used
Occupational adaptation is a guide for practice and as such, includes several additional concepts designed to expand the understanding of how occupational adaptation occurs and what actions and behaviors are involved. Thus, Table 3 offers definitions of concepts used in this analysis. Table 1 describes the four categories of how occupational adaptation has been used in research included: 1) understanding how occupational adaptation was used to manage occupational challenges and reconstruct occupational identity and competence in different life situations, 2) understanding how occupational adaptation was used for managing different health conditions as for example stroke, fatigue syndrome and dementia, 3) occupational adaptation for guiding occupational therapy practice, such as compared with a biomechanical approach or how used in relation to the occupational therapy process, and 4) occupational adaptation as part of instrument development.
Table 3. An overview of concepts and definitions.
Discussion
This scoping review aimed to identify and describe how occupational adaptation has been used in relation to different research topics and to identify possible research gaps in articles from 1992 to 2015. The results indicated several knowledge gaps. Despite Schkade and Schultz's theoretical approach being used in research, the theoretical model has not been further developed since it first was published in 1992.
Schultz (2014) presented a modified version of the original 1992 model, and Schkade has coauthored some articles to advance the OA model but no profound revision of the theoretical approach was found in the present review. Thus, in the future, research about occupational adaptation should be developed by a thorough and updated definition of core concept. Furthermore, to develop the conceptual foundation and get a deeper understanding of the theoretical constructions, the occupational adaptation theoretical approach could be related to other models or theories. Moreover, it is of great importance that theoretical approaches/models being systematically tested in new areas as the profession and society change and evolve.
While occupational adaptation is used in relation to different theoretical approaches (Kielhofner, 2008; Schkade & Schultz, 1992), it is used without further explanation or no theoretical approach. The lack of an identified theoretical approach could limit the understanding of which approach is used in the research project or practice setting. Furthermore, occupational adaptation in relation to different contexts, such as life situations and health conditions, are more often used in the research process rather than occupational adaptation in relation to occupational practice. For example, the study by McDougall, Buchanan, and Peterson (2014) described restrictions on developing new occupations or limited occupational engagement and was the only one that discussed negative adaptive strategies. The limitations of studies discussing negative adaptation indicate a research gap where more knowledge is needed about this phenomenon and its consequences for the feeling of coherence, meaning and health (Ikiugu & Ciaravino, 2007).
There are several instruments, Occupational Self-Assessment (OSA) (Baron, Kielhofner, Goldhammer, & Wolenski, 1999), Occupational Case Analysis Interview and Rating Scale (OCAIRS) (Kaplan & Kielhofner 1989), Occupational Performance History Interview (OPHI), (Kielhofner, Henry & Walens, 1989), based on the Model of Human Occupation that are designed to measure occupational adaptation. However, they do not measure a single construct of occupational adaptation, but several aspects such as competence, identity, and environment. There is only one instrument found, Relative Mastery Measurement Scale (George, Schkade, & Ishee, 2004) directly related to the occupational adaptation by Schkade and Schultz (1992). No application or development work concerning the instrument was found, which implies that it is seldom used. An instrument that operationalizes the concepts might make the theoretical approach more applicable in practice, but more research would be needed.
Most of the articles were conducted in the United States, Australia, Canada, and Sweden, and there was a lack of articles from less affluent countries. One probable reason is that the literature search was limited to English, which resulted in articles from English-speaking countries, which mostly belong to the affluent countries. As our literature search is based almost exclusively on articles from researchers in affluent countries, it is not yet known whether or how occupational adaptation applies to practical contexts in other parts of the world, indicating a knowledge gap. Furthermore, eleven out of thirty articles with Schkade and Schultz perspective of occupational adaptation were products of Texas Woman's University, United States. This also indicates that there is a need to broaden the research to other parts of the world and test the theory in different contexts.
There was also a predominance of studies based on qualitative designs. Quantitative designs were used in nine studies, and of those were three quasi-experimental. A predominance of qualitatively designed studies reveals a gap relating to the epistemology of studies and entails a need for more studies with quantitative and more robust designs (i.e., control trials instead of quasi-experimental designs).
The results showed a skewed demographic sample where most of the participants were middle-aged or over 65 years. These results highlight a gap in relation to the selection of participants, and consequently there is a need for studies with male participants and participants of a younger age. Furthermore, another research gap was identified regarding vulnerable groups due, for example, to the refugee situation or the increasing inequality and poverty in Europe, since the number of studies including vulnerable individuals such as immigrants (Nayar & Stanley, 2015) and homeless people (Johnson, 2006) were limited. Consequently, there is a need to expand the research on occupational adaptation to include vulnerable groups as well.
There were a limited number of articles focusing on health promotion. Although, Reitz, Scaffa, and Pizzi (2010) suggest that the theory of occupational adaptation, in line with Schkade and Schultz, is applicable in health promotion, only one article was found with this focus. Thus, to provide more scientific knowledge on the link between occupational adaptation and health promotion, further research is needed.
In a recent scoping review by Grajo and Boisselle (2018), the construct of occupational adaptation and its application in occupational therapy practice was described. Although their review applied a different aim compared to the present review, some similarities in research gaps were found. Both studies found lack of clear definitions of occupational adaption and descriptions of how it was used and lack of instruments measuring occupational adaptation. Furthermore, both studies found limitations in the use of occupational adaptation in relation to health promotion.
Limitations
One of the inclusion criteria was that the articles had to be written in English. With this limitation, it is possible that we missed important articles written in other languages. Another limitation was that the article search was limited to those available as “full text.” This is a methodological aspect, limited the results of the search and potentially excluded relevant articles. Further inclusion criteria were that the articles should be peer-reviewed research articles. On the one hand, this excluded for example, relevant master's or Doctoral theses, conference presentations or book chapters. On the other hand, peer-reviewed research articles most often are a guarantee of quality in research.
Conclusions
This scoping review achieved its aim of identifying and describing how occupational adaptation was used in relation to different topics and how knowledge gaps were made evident. This study suggested that the theoretical framework of occupational adaptation has limited application and empirical research support. However, the process of this scoping review is a good example of how to support occupational therapy practice by providing an overview of different arenas and approaches based on occupational adaptation. The practice can use the review for improving their understanding of occupational adaptation in different contexts and use good examples of how to apply occupational adaptation, especially in more traditional rehabilitation areas. However, the results show that further research is needed. The theoretical base of occupational adaptation and outcome measures need to be developed and further tested in research related to traditional areas as well as more new areas including e.g., community-based or health-promotion settings
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
| First author (Year)/Country | Aim | Design | Sample (n, age, F/M, characteristics) | Theoretical approach | How occupational adaptation (OA) was used |
|---|---|---|---|---|---|
| Garrett (1995)/USA | Test the validity of a model of professional development based on OA | Quantitative | 8, –, –, OT stud | Schkade & Schultz | For guiding OT practice |
| Brayman (1996)/USA | Describe health care supervisors' perception of a rapidly changing occupational environment | Qualitative | –, –, –, OT, PT, social workers, nurses, counselors | Schkade & Schultz | For understanding different life situations |
| Pasek (1996)/USA | Determine whether components of mastery and self-esteem could be identified | Mixed design | 14, 13–17, 7/7, teenagers' limb deficiency | Schkade & Schultz | For understanding different health conditions |
| Gibson (1997)/USA | Examine the use of OA frame of reference in the evaluation and treatment | Quasi-experimental | 50, 60–90, 30/20, CVA | Schkade & Schultz | For guiding OT practice |
| Buddenberg (1998)/USA | Compare biomechanical approach with OA frame of reference | Quasi-experimental | 20, 75–,20/0, hip fracture in rehab | Schkade & Schultz | For guiding OT practice |
| Mallinson (1998)/USA | Determine the construct validity of a modified version of OPHI scale | Quantitative | 20, 17–40, 10/10, clients psychiatric hospital | Kielhofner | Parts of instrument development |
| Lai (1999)/Sweden | Validate the internal validity of the OCAIRS and test the quality of rating scale | Quantitative | 145, 33–43, 81/64, patients psychiatric ward | Kielhofner | Parts of instrument development |
| Jackson (2001)/USA | Compare biomechanical– rehabilitation with OA frame of reference | Quasi-experimental | 40, 65–85,–, hip replacement | Schkade & Schultz | For guiding OT practice |
| Johnsson (2001)/USA | Explore the usefulness of OA frame of reference regarding intervention of mobility problems in CVA | Case study (mixed design) | 3, 65–88, 2/1, CVA at home | Schkade & Schultz | For guiding OT practice |
| Walker (2001)/USA | Determine therapists’ perceptions of how their practice has changed as a result of managed health care. | Qualitative | 25, –,–, 20/5, OT | Schkade & Schultz | For understanding different life situations |
| McIntyre (2002)/Australia | Explore and interpret an understanding of how daily occupations are experienced in widowhood | Qualitative | 1, 65–, 1/0, widow | Schkade & Schultz | For understanding different life situations |
| Dale (2002)/USA | Theorize how OTs are utilizing the holistic principles of the profession in providing client care within the constraints of cost containment | Qualitative | 5, 33–46, –/–, OT in hand therapy | Schkade & Schultz | For understanding different life situations |
| Gillot (2003)/USA | Explore and describe the perceptions and experiences of stroke patients who participated in constraint-induced therapy home program | Qualitative | 2, 42 + 65, 1/1, stroke clients in CI-therapy | Schkade & Schultz | For understanding different health conditions |
| Pentland (2003)/Canada | Expand the understanding of the lived experience of disability in women | Qualitative | 29,35–70, 29/0, spinal cord disability | Schkade & Schultz | For understanding different life situations |
| Taylor (2003)/USA | Conceptualizing the multiple factors that affect occupational adaptation in persons with Chronic Fatigue Syndrome (CFS) using MoHO as a frame | Qualitative | Fatigue-syndrom | Kielhofner | For understanding different health conditions |
| George (2004)/USA | Develop and evaluate a measure of relative mastery | Quantitative | 144, 22–92, 90/54, rehab patients | Schkade & Schultz | Parts of instrument development |
| Bontje (2004)/Netherlands | Explore the experience of occupational adaptation among persons with physical disabilities | Qualitative | 8, 72–88, 5/3, older persons with physical disabilities | Schkade & Schultz | For understanding different health conditions |
| Crist (2005)/USA | Present a partnership between faculty and practitioners and a data collection | Qualitative/Quantitative | 67, 18–68, 6/61, inmates | Kielhofner | For guiding OT practice |
| Klinger (2005)/Canada | To understand the process of occupational adaptation after traumatic brain injury | Qualitative | 7, 29–45, 1/6, post traumatic brain injury | Kielhofner | For understanding different health conditions |
| Johansson (2005)/Sweden | Examine whether the use of OA Model increases independence and experienced health for elderly at home | Integrated design | 19, 60–92, 15/4, disabled elderly at home | Schkade & Schultz | For guiding OT practice |
| Lee (2006)/Canada | Examined the occupations of individuals with dementia, the motives they have and the OA they make in response to their memory problems | Qualitative | 8, 75–90, 6/2, dementia at day program | Schkade & Schultz | For understanding different health conditions |
| Johnson (2006)/USA | Illustrate the value of the theory of OA in describing homelessness, | Qualitative / Case study | 4, 24–57, 2/2, homeless persons | Schkade & Schultz | For guiding OT practice |
| Vrkljan (2007)/Canada | Explore how changes in OA can influence individual Identity in older adulthood in driving and driving cessation | Qualitative / Case study | 2, 74/80, 1/1, healthy elderly living at home | Kielhofner | For understanding different life situations |
| Stelter (2007)/USA | Describe the development of an occupational therapy shelter workshop program | Qualitative | 11, –, –, 0/11, criminal offenders with mental illness. | Schkade & Schultz | For guiding OT practice |
| Bouteloup (2007)/Australia | Review the constructs and propositions of OA theory as applied to children | Qualitative / Case study | 1, 11, 0/1, severe behavioral problems | Schkade & Schultz | For guiding OT practice |
| Parson (2008)/Australia | Explore the experience of OA from the perspective of persons with brain injury | Qualitative | 2, 18–45, 0/2, acquired brain injury | Schkade & Schultz and others | For understanding different health conditions |
| Wiseman (2009)/Australia | Explore the retirement experience of old rural men | Qualitative | 8, 65–, 0/8, healthy older rural men | Kielhofner and others | For understanding different life situations |
| Rudman et al. (2010)/Canada | Describe the core aspects of living with low vision in old age | Qualitative | 34, 82, 26/8, old person with low vision | Kielhofner and others | For understanding different health conditions |
| Jack (2010)/USA | Illustrate a shift in approach from biomechanical to OA in orthopedic outpatients | Qualitative / Case study | 1, –, 1/0, arthritis patient | Schkade & Schultz | For guiding OT practice |
| Cahill (2010)/Ireland | Explore the OA of women with MS | Qualitative and Quantitative | 7, 30–46, 7/0, MS patients | Kielhofner | For understanding different health conditions |
| Yazdani (2011)/Jordan | Explore the way students explain their OA | Qualitative | 10, –, –, students with low level of life satisfaction | Kielhofner | For understanding different life situations |
| Soeker (2011)/South Africa | Describe the experience of returning to work and adaptive strategies used by persons with brain injury | Qualitative | 10, 31–64, 1/9, persons with mild to moderate brain injury | Kielhofner | For understanding different health conditions |
| Månsson (2011)/Sweden | Gain an enhanced understanding of how people with MS experience their occupational adaptation | Qualitative | 10, 41–67, 6/4, people with MS | Kielhofner | For understanding different health conditions |
| Johansson (2011)/Sweden | Describe the experience that women on long–term sick leave have of participation in occupation | Qualitative | 8, 44–58, 8/0, women with long sick leave | Kielhofner | For understanding different health conditions |
| Ammann (2012)/Switzerland | Understand how adults after a hand injury experience the impact of a hand disability on their occupations | Qualitative | 3, 48–66,2/1, persons with hand injury | Schkade & Schultz | For understanding different health conditions |
| Adami (2012)/USA | Demonstrate the insight occupational therapy brings to address client recovery in mental health | Qualitative | 1, –, 1/0, experiences OT in mental care | Schkade & Schultz | For understanding different health conditions |
| Williams (2013)/Australia | Investigate and describe older adults´ lived experience of OA following a stroke | Qualitative | 5, 68–78, 2/3, persons with stroke 10,74–91,7/3, | Schkade & Schultz | For understanding different health conditions |
| Norberg (2014)/ Sweden | Describe experiences of limitations in occupational performance and strategies for managing daily activities among elderly with heart failure | Qualitative | Elderly with heart failure | Schkade & Schultz | For understanding different health conditions |
| McDougall (2014) Australia | Explore the impact of caring for a person with an intellectual disability living in remote rural farming location on primary carers´ occupational engagement | Qualitative | 8,42–71, 7/1, primary carers | Schkade & Schultz | For understanding different life situations |
| Connell (2015)/UK | Initiate discussion of the value of OT contributions to risk assessment | Qualitative | 1, –, 0/1, client in forensic service | Kielhofner | For guiding OT practice |
| Beagan (2015)/Canada | Explore how individuals' experiences transition regarding spiritual and religious occupations after acknowledging identities with LGBTQ | Qualitative | 35, 20–61+, 11/19 (+ 4 trans,1 other), LGBTQ | Kielhofner | For understanding different life situations |
| Johansson (2015)/Sweden | Investigate whether a four-month occupational based health-promoting program could maintain/ improve health and wellbeing. Explore whether the program could facilitate occupational adaptation | Integrated design | 40, 76–92, 38/2, older person community dwelling | Schkade & Schultz | For guiding OT practice |
| Luck (2015)/Canada | Explore the transition from smoking to nonsmoking as an occupational transition | Qualitative | 7, 35–55, 7/0, women who had quit smoking | Schkade & Schultz | For understanding different life situations |
| Nastasi (2015)/USA | Examine the model of OA and Situational Leadership to create a framework to promote occupational engagement | Qualitative/ Case study | 1, 65+, 0/1, man with visual impairment | Schkade & Schultz | For guiding OT practice |
| Nayar (2015)/New Zealand | Contribute to the growing understanding of the concept of occupational adaptation and empirically test the theories. | Qualitative | 25, 18–, 25/0, women immigrated from India to New Zealand | Schkade & Schultz, Kielhofner, Nelson | For understanding different life situations |
n. a. = not applicable; OA = occupational adaptation in a general sense; OT = occupational therapy; PT = physiotherapy; – = not found in the article.
| Participants characteristics | Authors |
|---|---|
| Neurological problems | |
| Cerebral Vascular Accident (CVA) | Gibson & Schkade, 1997 Gillot et al., 2003 Johnsson, 2001 Williams & Murray, 2013 |
| Head injury | Klinger, 2005 Parson, 2008 Soeker, 2011 |
| Spinal cord injury | Pentland et al., 2003 |
| Multiple sclerosis (MS) | Cahill, 2010 Månsson Lexell, Iwarsson, & Larsson Lund, 2011 |
| Fatigue syndrome | Taylor et al. (2003) |
| Orthopedic problems | |
| Hip fracture | Buddenberg & Schkade, 1998 |
| Hip replacement | Jackson & Schkade, 2001 |
| Arthritis | Jack & Estes, 2010 |
| Hand injury | Ammann, Satink, and Andresen, 2012 |
| Older persons with disabilities | |
| Heart problem | Norberg, Boman, Löfgren, & Brännström, 2014 |
| Poor vision | Nastasi, 2015 Rudman et al., 2010 |
| Physical disability | Bontje et al., 2004 Johansson, 2005 |
| Dementia | Lee et al., 2006 |
| Healthy older persons | |
| Retirement experience | Wiseman & Whiteford, 2009 |
| From driving to driving cessation | Vrkljan & Polgar, 2007 |
| Experience from a health promotion program | Johansson, 2015 |
| Professionals working with | |
| Hand therapy | Dale et al., 2002 |
| Mental care | Adami & Evetts, 2012 |
| General health care | Brayman, 1996 Walker, 2001 |
| Students | |
| Professional development | Garrett & Schkade, 1995 |
| Low level of wellbeing and life satisfaction | Yazdani, Lloyd, & Ganvir, 2011 |
| Children | |
| Severe behavioral problems | Bouteloup & Beltran, 2007 |
| Limb deficiency | Pasek & Schkade, 1996 |
| Emerging groups | |
| Primary caregivers | McDougall et al., 2014 |
| Widows | McIntyre & Howie, 2002 |
| Persons who had quit smoking | Luck & Beagan, 2015 |
| Persons with long-term sick leave | Johansson, 2011 |
| Immigrated persons | Nayar & Stanley, 2015 |
| Inmates | Crist et al., 2005 |
| Criminal offenders with mental illness | Stelter & Whisner, 2007 |
| Clients in forensic service | Connell,2015 |
| Homeless persons | Johnson, 2006 |
| Lesbian, gay, bisexual, transgender or queer (LGBTQ) persons | Beagan & Hattie, 2015 |
| Concepts | Definitions |
|---|---|
| Adaptive response behavior | A person's internal response in meeting an occupational challenge “characterized by hyperstability (primitive), hypermobility (transitional), blended mobility and stability (mature)” (Schkade & Schultz, 1992, p. 834). |
| Adaptive strategies | “Sequences of chunks of action to improve life opportunities or enhance quality of life, often becoming part of a repertoire or style” (Frank, 1996, p.51). |
| Occupational challenge | A discrepancy between a person's capacity, the occupational demands, and the environmental resources and constraints (Law et al., 1996) |
| Occupational competence | “The degree to which one sustain a pattern of occupational participation that reflects one´s occupational identity” (Kielhofner, 2008, p. 107). |
| Occupational engagement | “Doing occupations in a manner that fully involves effort, drive and attention” (Christiansen & Townsend, 2010, p.8). |
| Occupational environment | The physical, social and cultural context in which work, play/leisure and self-care occur (Schultz, 2014). |
| Occupational identity | “A composite of who one is and wishes to become as an occupational being generated from one´s history of occupational participation” (Kielhofner, 2008, p. 106). |
| Occupational performance | “The complex interactions between the persons and the environments in which they carry out activities, tasks and roles that are meaningful to or required of them” (Christiansen, Baum, & Bass, 2011, p. 94). |
| Occupational transition | “A major change in the occupational repertoire of a person in which one or several occupations change, disappear, and/or are replaced by other” (Jonsson, 2010, p. 212). |
| Relative mastery | A self-rating assessment of “efficiency (use of time, energy, resources), effectiveness (the extent to which the desired goal was achieved), satisfaction to self and satisfaction to society” (Schultz, 2014, p. 532). |
References
- Adami, A. M., & Evetts, C. (2012). A natural approach in mental health practice: Occupational adaptation revealed. Occupational Therapy in Mental Health, 28(2), 170–179. doi: 10.1080/0164212X.2012.679589 [Taylor & Francis Online], [Google Scholar]
- Ammann, B., Satink, T., & Andresen, M. (2012). Experiencing occupations with chronic hand disability: Narratives of hand-injured adults. Hand Therapy, 17(4), 87–94. doi: 10.1177/1758998312471253 [Crossref], [Google Scholar]
- Arksey, H., & O'Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. doi: 10.1080/1364557032000119616 [Taylor & Francis Online], [Google Scholar]
- Baron, K., Kielhofner, G., Goldhammer, V., & Wolenski, J. (1999). The occupational self assessment (OSA) (Version 1.0). Chicago: Model of Human Occupation Clearinghouse, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago [Google Scholar]
- Beagan, B. L., & Hattie, B. (2015). LGBTQ experiences with religion and spirituality: Occupational transition and adaptation. Journal of Occupational Science, 22(4), 459–476. [Taylor & Francis Online], [Web of Science ®], [Google Scholar]
- Bontje, P., Kinébanian, A., Josephsson, S., & Tamura, Y. (2004). Occupational adaptation: The experiences of older persons with physical disabilities. American Journal of Occupational Therapy, 58(2), 140–149. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Bouteloup, Z., & Beltran, R. (2007). Application of the occupational adaptation framework in child and adolescent occupational therapy practice. A case study. Australian Occupational Therapy Journal, 54(3), 228–238. doi: 10.1111/j.1440-1630.2007.00620.x [Crossref], [Web of Science ®], [Google Scholar]
- Brayman, S. J. (1996). Managing the occupational environment of managed care. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 50(6), 442–446. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Buddenberg, L. A., & Schkade, J. K. (1998). Comparison of occupational therapy intervention approaches for older patients after hip fracture. Topics in Geriatric Rehabilitation, 13(4), 52–68. [Crossref], [Web of Science ®], [Google Scholar]
- Christiansen, C. H., & Townsend, E. A. (2010). An introduction to occupation. In C. H. Christiansen & E. A. Townsend (Eds.), Introduction to occupation: The art and science of living (2nd ed., pp. 1–34). Upper Saddle River, NJ: Pearson. [Google Scholar]
- Christiansen, C., Baum, C., & Bass, J. (2011). The person environment occupational performance (PEOP) model. In E. Duncan (Ed.), Foundations for practice in occupational therapy. (pp. 81–92). Edinburgh: Churchill Livingstone. [Google Scholar]
- Colquhoun, H. L., Levac, D., O'Brien, K. K., Straus, S., Tricco, A. C., Perrier, L., … Moher, D. (2014). Scoping reviews: Time for clarity in definition, methods, and reporting. Journal of Clinical Epidemiology, 67(12), 1291–1294. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Connell, C. (2015). An integrated case formulation approach in forensic practice: The contribution of occupational therapy to risk assessment and formulation. Journal of Forensic Psychiatry & Psychology, 26(1), 94–106. doi: 10.1080/14789949.2014.981566 [Taylor & Francis Online], [Web of Science ®], [Google Scholar]
- Crist, P., Fairman, A., Muñoz, J. P., Hansen, A. M. W., Sciulli, J., & Eggers, M. (2005). Education and practice collaborations: A pilot case study between a university faculty and county jail practitioners. Occupational Therapy in Health Care, 19(1–2), 193–210. doi: 10.1300/J003v19n0114 [Taylor & Francis Online], [Google Scholar]
- Dale, L. M., Fabrizio, A. J., Adhlakha, P., Mahon, M. K., McGraw, E. E., Neyenhaus, R. D., … Zaber, J. M. (2002). Occupational therapists working in hand therapy. The practice of holism in a cost containment environment. Work, 19(1), 35–45. [PubMed], [Google Scholar]
- Frank, G. (1996). The concept of adaptation as a foundation for occupational science research. In R. Zemke & F. Clark (Eds.), Occupational science. The evolving discipline (pp. 47–56). Philadelphia: F.A. Davis Company. [Google Scholar]
- Garrett, S. A., & Schkade, J. K. (1995). Occupational adaptation model of professional development as applied to level II fieldwork. American Journal of Occupational Therapy, 49(2), 119–126. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- George, L. A., Schkade, J. K., & Ishee, J. H. (2004). Content validity of the Relative Mastery Measurement Scale: A measure of occupational adaptation. OTJR: Occupation, Participation & Health, 24(3), 92–102. [Crossref], [Web of Science ®], [Google Scholar]
- Gibson, J. W., & Schkade, J. K. (1997). Occupational adaptation intervention with patients with cerebrovascular accident: A clinical study. American Journal of Occupational Therapy, 51(7), 523–529. doi: 10.5014/ajot.51.7.523 [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Gillot, A. J., Holder-Walls, A., Kurtz, J. R., & Varley, N. C. (2003). Perceptions and experiences of two survivors of stroke who participated in constraint-induced movement therapy home programs. American Journal of Occupational Therapy, 57(2), 168–176. doi:10.5014/ajot.57.2.168 [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Grajo, L., Boisselle, A., & DaLomba, E.. (2018). Occupational adaptation as a construct: A scoping review of literature. Open Journal of Occupational Therapy (OJOT), 6(1), 1–12. doi: 10.15453/2168-6408.1400 [Crossref], [Google Scholar]
- Ikiugu, M. N., & Ciaravino, E. A. (2007). Psychosocial conceptual practice models in occupational therapy: Building adaptive capability: Elsevier Health Sciences. [Google Scholar]
- Jack, J., & Estes, R. I. (2010). Documenting progress: Hand therapy treatment shift from biomechanical to occupational adaptation. American Journal of Occupational Therapy, 64(1), 82–87. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Jackson, J. P., & Schkade, J. K. (2001). Occupational adaptation model versus biomechanical-rehabilitation model in the treatment of patients with hip fractures. American Journal of Occupational Therapy, 55(5), 531–537. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Johansson, A., & Björklund, A. (2006). Occupational adaptation or well-tried, professional experience in rehabilitation of the disabled elderly at home. Activities, Adaptation & Aging, 30(1), 1–21. doi: 10.1300/J016v30n0101 [Taylor & Francis Online], [Google Scholar]
- Johansson, A., & Björklund, A. (2016). The impact of occupational therapy and lifestyle interventions on older persons' health, well-being, and occupational adaptation. Scandinavian Journal of Occupational Therapy, 23(3), 207–219. [Taylor & Francis Online], [Web of Science ®], [Google Scholar]
- Johnson, J. A. (2006). Describing the phenomenon of homelessness through the theory of occupational adaptation. Occupational Therapy in Health Care, 20(3–4), 63–80. doi: 10.1080/J003v20n03_05 [Taylor & Francis Online], [Google Scholar]
- Johnson, J. A., & Schkade, J. K. (2001). Effects of an occupation-based intervention on mobility problems following a cerebral vascular accident. Journal of Applied Gerontology, 20(1), 91–110. [Crossref], [Web of Science ®], [Google Scholar]
- Kaplan, K., & Kielhofner, G. (1989). Occupational case analysis interview and rating scale. Thorofare: Slack. [Google Scholar]
- Kielhofner, G., Henry, A., & Walens, D. (1989). A user’s guide to the occupational performance history interview. Rockville, MD: American Occupational Therapy Association. [Google Scholar]
- Kielhofner, G. (2002). Model of human occupation. Theory and application (third ed.). Philadelphia: Lippincott Williams & Wilkins. [Google Scholar]
- Kielhofner, G. (2008). Model of human occupation. Theory and application (fourth ed.). Philadelphia: Lippincott Williams & Wilkins. [Google Scholar]
- Klinger, L. (2005). Occupational adaptation: Perspectives of people with traumatic brain injury. Journal of Occupational Science, 12(1), 9–16. doi: 10.1080/14427591.2005.9686543 [Taylor & Francis Online], [Google Scholar]
- Lai, J.-S., Haglund, L., & Kielhofner, G. (1999). Occupational case analysis interview and rating scale: An examination of construct validity. Scandinavian Journal of Caring Sciences, 13(4), 267–273. doi: 10.1080/02839319950162462 [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The person-environment-occupation model: A transactive approach to occupational performance. The Canadian Journal of Occupational Therapy, 63(1), 9–23. doi: 10.1177/000841749606300103 [Crossref], [Google Scholar]
- Lee, M., Madden, V., Mason, K., Rice, S., Wyburd, J., & Hobson, S. (2006). Occupational engagement and adaptation in adults with dementia: A preliminary investigation. Physical & Occupational Therapy in Geriatrics, 25(1), 63–81. doi: 10.1300/J148v25n01_05 [Taylor & Francis Online], [Google Scholar]
- Levac, D., Colquhoun, H., & O'Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5(69), 1–9. doi: 10.1186/1748-5908-5-69 [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Luck, K., & Beagan, B. (2015). Occupational transition of smoking cessation in women: "You're restructuring your whole life". Journal of Occupational Science, 22(2), 183–196. doi:10.1080/14427591.2014.887418 [Taylor & Francis Online], [Web of Science ®], [Google Scholar]
- Mallinson, T., Mahaffey, L., & Kielhofner, G. (1998). The occupational performance history interview: Evidence for three underlying constructs of occupational adaptation. Canadian Journal of Occupational Therapy, 65(4), 219–228. [Crossref], [Google Scholar]
- McDougall, C., Buchanan, A., & Peterson, S. (2014). Understanding primary carers' occupational adaptation and engagement. Australian Occupational Therapy Journal, 61(2), 83–91. doi: 10.1111/1440-1630.12076 [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- McIntyre, G., & Howie, L. (2002). Adapting to widowhood through meaningful occupations: A case study. Scandinavian Journal of Occupational Therapy, 9(2), 54–62. doi: 10.1080/110381202320000034 [Taylor & Francis Online], [Google Scholar]
- Månsson Lexell, E., Iwarsson, S., & Larsson Lund, M. (2011). Occupational adaptation in people with multiple sclerosis. OTJR: Occupation, Participation and Health, 31(3), 127–134. doi: 10.3928/15394492-20101025-01 [Crossref], [Web of Science ®], [Google Scholar]
- Nastasi, J. A. (2015). Occupational leadership to facilitate occupational engagement in older adults with visual impairment. Topics in Geriatric Rehabilitation, 31(2), 121–128. [Crossref], [Web of Science ®], [Google Scholar]
- Nayar, S., & Stanley, M. (2015). Occupational adaptation as a social process in everyday life. Journal of Occupational Science, 22(1), 26–38. doi: 10.1080/14427591.2014.882251 [Taylor & Francis Online], [Web of Science ®], [Google Scholar]
- Nelson, D. (1997). Why the profession of occupational therapy will flourish in the 21st century. The American Journal of Occupational Therapy, 51(1), 11–24. doi: 10.5014/ajot.51.1.11 [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Nelson, D., & Jepson-Thomas, J. (2003). Occupational form, occupational performance, and a conceptual framework for therapeutic occupation. In P. Kramer, J. Hinojosa, & C. Royeen (Eds.), Perspectives in human occupation (pp. 87–155). Philadelphia: Lippincott Williams & Wilkins. [Google Scholar]
- Norberg, E.-B., Boman, K., Löfgren, B., & Brännström, M. (2014). Occupational performance and strategies for managing daily life among the elderly with heart failure. Scandinavian Journal of Occupational Therapy, 21(5), 392–399. doi: 10.3109/11038128.2014.911955 [Taylor & Francis Online], [Web of Science ®], [Google Scholar]
- O’Brien, K. K., Colquhoun, H., Levac, D., Baxter, L., Tricco, A. C., Straus, S., … O’Malley, L. (2016). Advancing scoping study methodology: A web-based survey and consultation of perceptions on terminology, definition and methodological steps. BMC Health Services Research, 16(305). doi: 10.1186/s12913-016-1579-z [Crossref], [Google Scholar]
- Parsons, L., & Stanley, M. (2008). The lived experience of occupational adaptation following acquired brain injury for people living in a rural area. Australian Occupational Therapy Journal, 55(4), 231–238. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Pasek, P., & Schkade, J. K. (1996). Effects of a skiing experience on adolescents with limb deficiencies; An occupational adaptation perspective. The American Journal of Occupational Therapy, 50(1), 24–31. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Pentland, W., Walker, J., Minnes, P., Tremblay, M., Brouwer, B., & Gould, M. (2003). Occupational responses to mid-life and aging in women with disabilities. Journal of Occupational Science: Australia, 10(1), 21–30. [Taylor & Francis Online], [Google Scholar]
- Reed, K. (2015). Key occupational therapy concepts in the person-occupation-environment-performance mode. Their origin and historical use in the occupational therapy literature. In C. H. Christiansen, C. M. Baum & J. D. Bass (Eds.), Occupational therapy. Performance, participation and well-being. Thorofare: SLACK Incorporated. [Google Scholar]
- Reitz, S. M., Scaffa, M. E., & Pizzi, M. A. (2010). Occupational therapy conceptual models for health promotion practice. In M. E. Scaffa, S. M. Reitz, & M. A. Pizzi (Eds.), Occupational therapy in the promotion of health and wellness (pp. 22–45). Philadelphia: F.A. Davis Company. [Google Scholar]
- Rudman, D. L., Huot, S., Klinger, L., Leipert, B. D., & Spafford, M. M. (2010). Struggling to maintain occupation while dealing with risk: The experiences of older adults with low vision. OTJR: Occupation, Participation and Health, 30(2), 87–96. doi: 10.3928/15394492-20100325-04 [Crossref], [Web of Science ®], [Google Scholar]
- Schkade, J., & Schultz, S. (1992). Occupational adaptation: Toward a holistic approach for contemporary practice, part I. American Journal of Occupational Therapy, 46(9), 829–837. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Schkade, J., & Schultz, S. (2003). Occupational adaptation. In P. Kramer, J. Hinojosa, & C. Royeen (Eds.), Perspectives in human occupation (pp. 181–221). Philadelphia: Lippincott Williams & Wilkins. [Google Scholar]
- Schultz, S. (1997). Infusing occupation into practice. Montgomery Lane: American Occupation Therapy Association. [Google Scholar]
- Schultz, S. (2014). Theory of occupational adaptation. In B. A. Schell, G. Gillen, & M. E. Scaffa (Eds.), Willard & Spackman's Occupational Therapy (12th ed., pp. 527–540). Philadelphia: Lippincott Williams & Wilkins. [Google Scholar]
- Schultz, S., & Schkade, J. (2003). Occupational adaptation. In E. B. Crepeau, E. S. Cohn, & B. A. B. Schell (Eds.), Willard & Spackman´s occupational therapy (10th ed., pp. 220–223). Philadelphia: Lippincott, Williams, and Wilkins. [Google Scholar]
- Soeker, M. S. (2011). Occupational adaptation: A return to work perspective of persons with mild to moderate brain injury in South Africa. Journal of Occupational Science, 18(1), 81–91. doi: 10.1080/14427591.2011.554155 [Taylor & Francis Online], [Google Scholar]
- Stelter, L., & Whisner, S. M. (2007). Building responsibility for self through meaningful roles. Occupational adaptation theory applied in forensic psychiatry. Occupational Therapy in Mental Health, 23(1), 69–84. [Taylor & Francis Online], [Google Scholar]
- Taylor, R. R., Kielhofner, G. W., Abelenda, J., Colantuono, K., Fong, T., Heredia, R., … Vazquez, E. (2003). An approach to persons with chronic fatigue syndrome based on the model of human occupation: Part one, impact on occupational performance and participation. Occupational Therapy in Health Care, 17(2), 47–61. [Taylor & Francis Online], [Google Scholar]
- Walker, K. F. (2001). Adjustments to managed health care: Pushing against it, going with it, and making the best of it. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 55(2), 129–137. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Williams, S., & Murray, C. (2013). The lived experience of older adults' occupational adaptation following a stroke. Australian Occupational Therapy Journal, 60(1), 39–47. doi: 10.1111/1440-1630.12004 [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Wiseman, L., & Whiteford, G. (2009). Understanding occupational transitions: A study of older rural men's retirement experiences. Journal of Occupational Science, 16(2), 104–109. [Taylor & Francis Online], [Google Scholar]
- Vrkljan, B. H., & Polgar, J. M. (2007). Linking occupational participation and occupational identity: An exploratory study of the transition from driving to driving cessation in older adulthood. Journal of Occupational Science, 14(1), 30–39. doi: 10.1080/14427591.2007.9686581 [Taylor & Francis Online], [Google Scholar]
- Yazdani, F., Lloyd, C., & Ganvir, S. (2011). How students with low level subjective wellbeing perceive the impact of the environment on occupational behaviour. International Journal of Therapy & Rehabilitation, 18(8), 462–470. [Crossref], [Google Scholar]