Canadian Journal of Occupational Therapy

Description. Considérant ses conséquences négatives, l’usage excessif des écrans constitue un véritable enjeu de santé publique en jeunesse. Afin de mieux soutenir les jeunes dans l’adoption d’un mode de vie sain et porteur de sens, il importe de s’appuyer sur des interventions probantes. L’approche ergothérapique Remodeler sa vie permettrait d’agir en ce sens, mais elle n’a pas encore été documentée ni explorée auprès de cette population. But: Exposer la pertinence d’adapter et d’expérimenter l'approche Remodeler sa vie auprès des jeunes faisant un usage excessif des écrans, en vue d’inspirer la réalisation de projets de recherche ou d'innovation dans des milieux de pratique en jeunesse. Questions clés: Plusieurs jeunes font un usage excessif des écrans durant leurs activités de loisir. Lors du passage vers l’adolescence, les jeunes tendent à accroître leur temps d’écran durant leurs activités de loisir, mais aussi à s’isoler socialement, à s’ennuyer, ainsi qu’à remplacer l’activité physique par des activités sédentaires. Ce faisant, ces jeunes bénéficieraient d’interventions probantes pour accroître leur équilibre de vie. Implications. La réalisation d’un projet sur l’adaptation et l’expérimentation de l’approche Remodeler sa vie pour les jeunes permettrait de répondre à ce besoin. Ce projet pourrait inclure des jeunes de 10 à 12 ans, leurs parents et des partenaires clés. L’intervention gagnerait à s’appuyer sur d’autres pratiques probantes en matière d’engagement et de réduction du temps d’écran et à viser, entre autres, le développement du répertoire d’intérêts des jeunes.

Background. Studying the implementation of occupation-based stroke prevention interventions in primary healthcare is necessary and will provide insights of interventions’ feasibility in clinical practice. Purpose. To explore the implementation of the Make My Day (MMD) stroke prevention intervention in Swedish primary healthcare with health professionals (HPs) and among persons at risk for stroke. Method. The Medical Research Councils process evaluation framework domains, implementation, mechanisms of impact and context, guided investigation of the implementation. Data were collected through logbooks, fieldnotes, and interviews. Descriptive statistics were used to analyze process data while thematic analysis was applied to explore experiences of and interactions with the MMD intervention and contextual influences. Results. There was a high belief in using engaging occupations to facilitate lifestyle habit change among HP's and persons at risk for stroke. The HP's complementary competencies, sharing experiences within groups and digital self-monitoring was valued. Time constraints and age differences in groups impacted MMD delivery. Reaching a representative sample, and different Swedish primary healthcare settings was challenging. Conclusion. The occupation-based framework and intervention implementation was feasible yet sustainability in Swedish primary healthcare requires securing HP staff and time to deliver prevention like MMD, and reaching hard-to-reach groups in the study population.

Background. While it is a well-recognized and cost-effective preventive occupational therapy (OT) intervention, the impact of the Lifestyle Redesign^® training, including its French version, is unknown. Purpose. This study aimed to explore experience of French–Canadian OTs and students about the Lifestyle Redesign^® training and its influence on their knowledge and behavioural intention. Method. A cross-cultural validation and action research were used including a pre-experimental component (OTs questioned before and after the training). Semi-directed focus groups were digitally audiotaped and transcribed, which then underwent thematic content analysis. Findings. Aged between 22 and 60, 24 women (20 OTs and four OT students) completed the French version of the Lifestyle Redesign^® training. Participants welcomed access to a French version of the approach and reported that the themes covered were adapted to the Quebec context, but a more “turnkey” and socio-constructivist course should be considered. The French Lifestyle Redesign training was found to increase participants’ knowledge (p < .01) but not their intention to offer the approach to their older clientele over the next year. Conclusion. Lifestyle Redesign^® is a culturally promising training and its French–Canadian version can be further optimized to best support OT needs, foster adoption into practice, and address emerging realities.

Background. Chronic pain brings on many lifestyle changes. Redesign your Everyday Activities and Lifestyle with Occupational Therapy (REVEAL(OT)) is an evidence-based Danish intervention that benefits the daily functioning of individuals living with chronic pain. Purpose. To understand the perspectives of patients, clinicians and managers about REVEAL(OT) and identify format- and content-related modifications that are necessary to adapt to the Canadian context. Method. Based on a qualitative descriptive approach, focus groups and individual interviews with partners (n = 45 participants in total) were conducted in two Montreal specialized pain clinics. The interview guide was inspired by Proctor's implementation model and a qualitative rapid analysis was performed. Findings. Participants recognized the need for (a) a flexible, personalized and hands-on intervention, (b) integrating multimodal approaches, (c) support to develop and implement healthy life habits, (d) addressing gaps in care supporting the need for an OT intervention, and (e) pragmatic organisational considerations for implementation. Conclusion. REVEAL(OT) is capable of addressing the occupational needs of patients but adaptations are required to fit within a new healthcare ecosystem. Our findings promote the use of lifestyle-oriented interventions along with current care and will generate the initial intervention manual to be tested and refined.

Background. Numerous risk factors for stroke are modifiable and are associated with lifestyle and daily habits. An occupational perspective in prevention, which emphasizes habits and routines, can facilitate sustainable and healthy lifestyle changes. Additionally, lifestyle changes generally take place within a social context, making family involvement indispensable. Purpose. This study aims to explore family support from the perspective of persons with risk for stroke (PWRS) who participated in an occupation-based stroke prevention program, and their family members. Method. Explorative qualitative design using interviews was conducted with 10 PWRS who participated in the Make My Day intervention and 10 family members of intervention participants, including both married and nonmarried partners and adult children. Data were analyzed using an inductive semantic approach and reflexive thematic analysis. Findings. Family support depends on the nature of relationships, the family's willingness to accept support, and expectations. Three themes were generated through the analysis: (a) shared perspectives on lifestyle influence support, (b) balancing support and individual responsibility, and (c) generating tensions from different views on health and lifestyle habits. Conclusion. Family support encourages lifestyle changes by sharing activities, offering encouragement, and providing positive reinforcement. Nonetheless, difficulties can occur in maintaining a balance between supporting family members and respecting their personal responsibility, particularly when family members have varying levels of understanding regarding health.

Background: In primary care (PC) clinical, healthcare utilization, and financial outcomes associated with Lifestyle Redesign^® Occupational Therapy (LR-OT), a framework that incorporates healthy habits into daily routines, are not well documented in the United States. Purpose: (a) Compare clinical outcomes, healthcare utilization, and associated cost differences between patients who received LR-OT and a control group. (b) Assess the investment required integrate LR-OT into PC. Method: LR-OT was integrated into a safety-net PC clinic. In a hybrid effectiveness-implementation clinical trial (#NCT03293914), clinical (glycated hemoglobin A1c [HbA1c], blood pressure, cholesterol, and body mass index) and utilization (outpatient, emergency department [ED], hospital visits) data were extracted from medical records of provider-referred adults with diabetes (HbA1c ≥ 9.0%) who were willing to make lifestyle changes. Results: Of 155 referred patients, 142 were randomized to LR-OT (n = 73) or a control group (n = 69), and 42 completed eight LR-OT sessions within 6 months. Underpowered clinical outcomes indicated no significant change, with aggregated trends suggesting LR-OT supports sustained cardiometabolic improvement. Savings of $250,518.96 is attributed to LR-OT, driven by significant decreases in ED visits (p = .03) and hospital days (p = .03), despite nonsignificant increases in outpatient utilization. The projected cost-benefit of integrating a full-time LR-OT in PC is $352,326.72 with a 236% return on investment. Conclusion: Clinical trends and significant reductions in acute care services drove healthcare-wide cost savings, demonstrating clinical and financial value of integrating LR-OT into PC.

Background. Although Lifestyle Redesign^® is an important preventive occupational therapy approach fostering meaningful routines to support health and well-being, little data exists to support its implementation in new sociocultural contexts. Purpose. To explore facilitators and barriers to a future implementation of the French-Canadian Lifestyle Redesign^® (Remodeler sa vie^®) in occupational therapy practice, as perceived by occupational therapists (OTs), occupational therapy students, decision makers and community partners. Method. Guided by the Consolidated Framework for Implementation Research, this action-research study involved 58 purposefully selected participants trained in the approach. Eleven focus groups were conducted using three semi-structured interview guides and facilitation tools. Findings. Participants (86.2% women, aged 20 to 72; mean = 43.2, SD = 12.5) identified 36 influential factors, with public sector OTs facing the most barriers. Key facilitators included the approach's strong evidence base, its relevance to aging populations, key actors’ openness and engagement, and new social trends. Barriers stemmed from the approach's complexity, resource constraints, socio-political challenges, implementation efforts and uncertainty about older adults’ engagement in this approach. Equitable access to the approach was a common concern. Conclusion. By addressing the factors influencing the implementation of Remodeler sa vie^®, this study advances knowledge on integrating preventive approaches to promote healthy aging in Canada and internationally.

Background. Presented as a response to unmet social needs and a way toward a more equitable, sustainable, and healthier society, social prescribing (SP) is gaining international attention. However, it also faces challenges and criticisms, particularly regarding its evidence base, implementation processes, and relevance across diverse contexts. To date, little is known about its compatibility with preventive occupational therapy, notably with Lifestyle Redesign (LR), a landmark intervention that shares similarities with SP. Purpose. To synthesize knowledge about SP, its areas of compatibility and tension, as well as its linkages with LR. Key issues. While evidence regarding SP is conflicting, a critical examination of its connection with LR could help better meet the complex and evolving needs of older adults, especially those facing structural or social marginalization. Given their affinities, SP and LR present several promising points of integration, including: (1) offering LR within social prescription, (2) assigning a dedicated SP navigator to LR, and (3) positioning occupational therapists as SP navigators. Implications. Linking social prescribing and LR could contribute to tackling global public health priorities such as loneliness, social isolation, and chronic diseases, while advancing knowledge and practices that empower occupational therapists to address social determinants of health.

Background. Engagement in meaningful social and everyday activities is crucial for maintaining overall well-being and quality of life. However, individuals diagnosed with dementia are more likely to experience a decline in participation, which can lead to social isolation and loneliness. This highlights the need for programs that help individuals to adapt to the changes following a dementia diagnosis. Journeying through Dementia (JtD) is one such program, designed to encourage continued meaningful participation. Purpose. This study aimed to explore the feasibility of implementing the JtD program in Quebec and to collect preliminary data to inform future trials. Five feasibility criteria were assessed: (a) acceptability of the program; (b) appropriateness of content and delivery; (c) adherence and retention; (d) suitability of recruitment strategies; and (e) appropriateness of outcome measures. Methods. A single-site exploratory feasibility study was conducted, guided by the Medical Research Council (MRC) framework. The intervention consisted of eight 2-hour group sessions held at a research center. The MRC framework also guided data collection and analysis. Finding. Three participants completed the program. They reported several benefits and found both the content and delivery appropriate. Adherence and retention rates were high. Partners also expressed interest in participating in the study and contributed valuable insights. Feedback on recruitment and the use of outcome measures was provided for consideration in the next phases of the study. Conclusion. Findings support the feasibility and acceptability of the JtD program in the Québec context and highlight considerations for future evaluation.