Vergelyking van 'n aktiwiteit- en uitkomsgebaseerde program in arbeidsterapie
The establishment of occupational science in 1989 created an occupational discourse that defused the debate regarding the difference between activity and occupation. This fundamental discipline employs the applied science in occupational therapy and has directed the profession back to the original paradigm of occupational therapy, namely occupation (Cole & Tufano, 2008:59; Hagedorn, 1995:79). Occupational therapy recognises the unique occupations of each individual in the context of personal experience and applies occupation as part of the therapeutic process. Scientific proof of an occupational focus to enable the mental health care user (MHCU) to function optimally in the community after discharge, is necessary (AOTA, 2008:625, 626, 664). An occupational focus firstly involves the understanding of the therapeutic power of occupation as described by Pierce (2003:9). This consists of the subjective dimension, contextual dimension and application of an occupation based approach. Secondly, occupation is used as both means and as ends, to enable the MHCU to become skilled in his / her own life tasks and roles. The aim is to optimize functioning in the community (Trombly, 1995:963; 2002b:257). For the study, a retrospective match-control study design was used in a quantitative approach. An activity- and outcome based program were compared in order to investigate the effectiveness of the respective programs. Approval for the execution of the study was granted by the Ethics committee, Faculty of Health Science, University of the Free State (ETOVS nr. 12/2011). The occupational therapy files of hundred and two MHCU’s, 51 from the activity program and 51 from the outcome based program, were included in the study. Files were matched according to specific criteria, namely age, gender, diagnosis, language and educational level. The files of MHCU’s that had attended the activity program from 2009 to June 2011 were matched with files of MHCU’s that attended the outcome based program from July 2011 till Julie 2012. The data (pre-and post test) was abstracted from the occupational therapy evaluation, which was based on the ICF (International Classification of Functioning, Disability and Health) and recorded in the occupational therapy process notes. The researcher entered all the data from the files onto data forms. The results of the pre- and post tests of both programs were analysed, and the clinical improvement of MHCU’s in each program and the similarities of the program were compared to one another. The Department of Biostatistics, University of the Free State used descriptive statistics to analyse the collected data. Clinical and statistical significant improvements were observed in both programs. The largest clinical improvement in the activity program was seen in occupational performance components like attention, motivation, energy levels, decision making and range of emotion. In the outcome based program, the largest clinical improvement was found in functional aspects like handling of stress, management of own health and managing daily routine. Statistical significant differences in the activity program were noted in the components of motivation, handling own activity level, complete daily routine and in informal relationships. Statistical significant differences in the outcome based program was noted in the components regarding handling of stress, management of own health, time management, insight and social cues in relationships. The findings from this study indicated that the activity program addressed the occupational performance components more effectively, while the outcome based program was more effective in addressing functional skills. From the findings, it is proposed that a combined program be developed, consisting of elements from both programs, such as, activities and occupations that would address OPC’s and OPA’s through the use of psychomotor activity, craft activities and life skills groups. This should be combined into a full day program. Further research is recommended to gain further clinical proof of the value of an occupational focus in occupational therapy practise, and to verify the conclusions of this study.
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