Theory to Practice in Action: A Research and Program Commitment at Griffith University

Louise Gustafsson, Michelle BissettandMatthew Molineux, Griffith University

The unique contribution of occupational therapy is the profession’s occupationcentred approach to promoting health and well-being. However, change has been slow following the renaissance of occupation and a theory-to-practice gap persists within clinical practice. We believe research holds an important role in supporting changes to occupational therapy practice consistent with the following three core constructs of the contemporary paradigm: occupation is inextricably linked to health and wellbeing, humans can experience dysfunction in their occupations, and occupation-based practice. At Griffith University (GriffithOT) we are committed to supporting the profession to bridge the theory-to-practice gap through research partnerships with all stakeholders. Our research agenda aims to:

• Demonstrate the value of occupation and occupational therapy practice to health and well-being • Build evidence-based approaches to support student occupational therapists and practitioners to integrate theory into practice

In this article we summarise some of our key work, findings, and implications for the profession. Through doing so, we aim to inspire other occupational therapy researchers and clinicians to consider how they can contribute to the theory-to-practice evidence base and bridge the theory-to-practice gap.

Occupation in Practice

Our research has identified that occupationbased practice is valued by the profession and satisfaction is high for consumers1,2 . We found that clinicians working in an acute paediatric setting recognised the power of occupation and the benefits of an occupation-based approach, and incorporated these in practice, albeit inconsistently3. The clinicians identified barriers external to themselves such as working within the medical model, workplace expectations, and multidisciplinary team understanding. However, scoping reviews from other practice settings suggest that a common problem is the disconnect between the planned outcomes and the interventions that we implement. For example, occupationbased interventions are often implemented within a residential setting but the key outcomes are often measured at a person level4–or within hand therapy settings, the push of a biomedical culture and pull of an occupational perspective means there is often an expectation that component level interventions will directly translate into improved occupational engagement 5,6 .

While these findings suggest the intent, and attempts, to work within the contemporary paradigm, they also challenge the profession to make the occupational perspective explicit. Supervision and/or professional development to refresh knowledge and skills in occupational therapy conceptual practice models—and to support integration of occupation throughout all of the practice process—can assist. One of our current projects involves working alongside occupational therapists in an acute setting to coach and strengthen occupation-centred practice. Intentionally increasing knowledge, skills, and confidence for implementing occupation-based practice and the changes required for documentation and intervention protocols is not only important for the profession, but also to outwardly demonstrate this perspective to the interprofessional team. Language is a powerful tool that can be used to support occupational therapists who often feel unable or unsure of how to engage in occupation-based practice. As one example, the term ‘function’ is often used interchangeably with ‘occupation’ and used variably by the interprofessional team. A conscious decision to change language and documentation to include terms such as occupation, occupational performance and engagement, and enabling occupation is a simple but powerful step to prioritising occupation in practice.

Understanding how occupation is conceptualised within the profession and experienced by our clients are two other areas of focus for our research. A concept analysis of the term ‘occupational adaptation’ found it was used variably across multiple contexts, however it lacked maturity and concept refinement was required7. Interviews with stroke survivors found that reconstruction of an occupational identify was central to adjustment and was facilitated through connections to self, reality, and others8. Explorations of the experience of occupation for stroke survivors has found that rehabilitation was most valued when there was an explicit link between the therapy and the persons’ occupations 9,10. Further people with mild stroke identified persistent occupational gaps in outdoor activities, work, sports, and light and heavy home maintenance11. Understanding how occupation is experienced by our clients is essential to building the evidence base and contributing to service development.

Occupation in Supervision

Supporting clinical supervisors to integrate occupational therapy concepts and theory into supervisory processes is another key enabler for change. Our research reveals that common barriers to occupation-based practice for new and recent graduates include the pressure to practise in a manner accepted and expected by senior members of the profession and the multidisciplinary team12. As a new graduate, they have emerged from a period of intense learning and application of occupational therapy theory, models, and frameworks. However, the graduates in this study were most comfortable implementing impairment-based practice and considered their practice would become increasingly occupation-based with growing experience and confidence. The existence of this theory-to-practice gap early in their career highlights a key dilemma for the profession. Supervision is an important enabler but can only be effective if both the clinician and the practice context supports occupation-based practice. As evidenced by a collaboration with a local health service, learning packages can support supervisors to incorporate theory into their supervision sessions with early-career staff 13 .

A conscious decision to change language and documentation to include terms such as occupation, occupational performance and engagement, and enabling occupation is a simple but powerful step to prioritising occupation in practice.

Occupation in Education

Leaders within the profession have identified three core characteristics of occupationcentred education: embodied knowledge and understanding of occupation and its link to health and well-being, deliberate educators who value occupation, and rhetoric versus reality of professional practice14. University-based educators are the instruments of occupation-centred education–it is their in-class strategies and use of tools, models, and frameworks that link occupation to practice and support the students to learn and embody occupation15 . Our program includes annual theory-topractice transition workshops that assist students to link theoretical concepts to practice16. These focused workshops enhance student knowledge and confidence in applying theoretical concepts to practice contexts. There are opportunities to extend this concept to practice education supervisors, as students will often experience ‘dilemmas’ when occupation is not explicit within the practice area, with detrimental impacts on professional identity. Harnessing and developing supervisor knowledge regarding contemporary practice, and supporting them to understand that this knowledge is powerful and important, is a key precursor to change.

Occupation in Research is Needed to Bridge the Theory-to-Practice Gap

In this article we have summarised some, but not all, of the research undertaken by GriffithOT academics, higher-degree research students, and honours students. Collectively, we remain committed to bringing occupation to the fore to support practice, education, and supervision, and to ensure that occupational therapy retains its unique place within any team. We work in partnership with clinical teams, ensuring that change and implementation are feasible within practice settings. We encourage other occupational therapists to consider how their work can build the evidence and/or advance theoryto-practice translation–perhaps through research partnerships or through deliberate practice decisions which proactively position occupation into their work. We welcome contact from people interested in joining the GriffithOT research agenda.

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