OCCUPATIONAL THERAPY NOW2 occupational therapy now volume 9.1 Statements made in contributions to Occupational Therapy Now are made solely on the responsibility of the author and unless

read full colour version @ www.caot.ca 1

Table of Contents3 Canadian Working Group on HIV and Rehabilitation: Involvement and opportunities

for occupational therapistsDeb Cameron, Todd Tran and Gillian Bone

6 Stable, Able and Strong Project: Meet our site coordinators

7 Plan to attend the CAOT Conference 2007 in St. John’s, Newfoundland and LabradorTanya Baglole

8 Information Gateway: Where CAOT members go to find the evidence they needKathy Van Benthem

11 Sense of DoingRe-capturing an important piece of self through leisure occupationsSusan Yee

14 Staff changes at the CAOT National OfficeTanya Baglole

15 Highlights from CAOT meetings in Regina during November 2006Tanya Baglole

16 Workforce Integration Project: Final recommendationsClaudia von Zweck

17 Critically Appraised PapersEnergy conservation course was found to reduce the impact of fatigue, improve aspectsof quality of life and increase self-efficacy in those who have multiple sclerosis.

22 OT Atlantic Conference 2006 Seas of Change: A phenomenonJude Driscoll

23 CAOT: On your behalf

26 Update from the COTF

28 CAOT endorsed courses

THERAPY NOWOCCUPATIONAL

january/february 2007 • VOLUME 9 • 1

Cover photo courtesy of Newfoundland and Labrador Tourism

Occupational Therapy Now is published 6 times a year (bimonthly beginning with January) by

the Canadian Association of OccupationalTherapists (CAOT).

MANAGING EDITORFern Swedlove, BScOT, Diploma in Communications

Tel./Fax. (204) 453-2835 (MB)E-mail: [email protected]

TRANSLATIONDe Shakespeare à Molière, Services de traduction

DESIGN & LAYOUTJAR3communications

ON-LINE KEY WORD EDITORKathleen Raum

CAOT EDITORIAL BOARDChairperson: Catherine Vallée Members:

Pam Andrews, Emily Etcheverry, Gail Langton,Anita Unruh & Brenda Vrkljan

Ex-officio: Marcia Finlayson & Fern Swedlove

COLUMN EDITORSCritically Appraised Papers

Lori Letts, PhDInternational Connections

Sandra Bressler, MEd In Touch with Assistive Technology

Roselle Adler, BScOT & Josée Séguin, MScPrivate Practice InsightsLorian Kennedy, MScOT

Sense of DoingHelene J. Polatajko, PhD & Jane A. Davis, MSc

Tele-occupational TherapyLili Liu, PhD & Masako Miyazaki, PhD

Theory Meets PracticeHeidi Cramm, MSc

Watch Your PracticeSandra Hobson, MAEd

occupational therapy now volume 9.12

Statements made in contributions toOccupational Therapy Now are madesolely on the responsibility of theauthor and unless so stated do notreflect the official position of CAOT, andCAOT assumes no responsibility forsuch statements. Occupational TherapyNow encourages dialogue on issuesaffecting occupational therapists andwelcomes your participation.

EDITORIAL RIGHTS RESERVEDAcceptance of advertisements does notimply endorsement by OccupationalTherapy Now nor by the CanadianAssociation of Occupational Therapists.

CAOT PATRONHer Excellency the Right Honourable Michaëlle Jean C.C., C.M.M., C.O.M., C.D.Governor General of Canada

CAOT PRESIDENTSue Forwell, PhD

CAOT EXECUTIVE DIRECTORClaudia von Zweck, PhD

RETURN UNDELIVERABLECANADIAN ADDRESSES TO:CAOT – CTTC Building3400 – 1125 Colonel By Drive Ottawa,Ontario KIS 5R1 CANE-mail: [email protected]. (613) 523-2268Tel. (800) 434 -CAOT (2268)Fax. (613) 523-2552www.caot.ca • www.otworks.ca

ADVERTISINGLisa Sheehan(613) 523-2268, ext. 232e-mail: [email protected]

SUBSCRIPTIONSLinda Charney(613) 523-2268, ext. 242e-mail: [email protected]

COPYRIGHTCopyright of Occupational Therapy Nowis held by the Canadian Association ofOccupational Therapists. Permissionmust be obtained in writing from CAOTto photocopy, reproduce or reprint anymaterial published in the magazineunless otherwise noted. There is a perpage, per table or figure charge forcommercial use. Individual members ofCAOT or ACOTUP have permission tophotocopy up to 100 copies of an articleif such copies are distributed withoutcharge for educational or consumerinformation purposes.

Copyright requests may be sent to:Lisa SheehanCanadian Association of Occupational Therapists (CAOT)CTTC Bldg., Suite 34001125 Colonel By DriveOttawa, ON.Canada K1S 5R1Tel. (613) 523-2268, ext. 232Fax. (613) 523-2552e-mail: [email protected]

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Letter to the editorCongratulations on the article in the September/October Special Edition of Occupational Therapy Now onCOTA (Changing Community-Based Services: COTA Comprehensive Rehabilitation and Mental Health Services,by Tanya Baglole). COTA is and was a truly remarkable organization. Ahead of its time at its inception in thenineteen seventies, it paved the way for occupational therapists all over Canada to shine in the communitysetting. Tanya Baglole did a wonderful job of writing an inspirational narrative of the history of COTA. There is a wonderful captioned photograph of the five founders, occupational therapists, all.

However, in the “Highlights of COTA History” sidebar, there was rather an odd lack of balance. Two individuals are mentioned by name at the changeover of executive directorship that occurred in 2000-01.I thought that having done that, it was an incredible oversight to neglect to mention the exceptional leadership of COTA’s first executive director, Karen Goldenberg. Her positive energy and her encouragementof creativity produced a fertile ground in which many remarkable seeds of innovations sprouted and thrived.Her dynamic leadership was without doubt a huge factor in the unprecedented growth and early success of this important organization. It would be wonderful to feature a series giving credit to the talented occupational therapists that contributed to the amazingly rapid growth of this organization during its early years; and to do justice to the innovations that evolved during this fecund period.

Elaine McKee OT Reg. (Ont.)

Reply from the editor Thank you for your letter to the editor regarding the profile of COTA that appeared in the September issue of OT Now. You raise a very important point about the omission of Karen Goldenberg as the firstexecutive director of COTA and her valued contribution to the organization.

This article, the first of a two part series, will focus onhow and why occupational therapists have becomeinvolved in a variety of roles with the CanadianWorking Group on HIV and Rehabilitation (CWGHR)and opportunities for future involvement. The secondarticle will focus more specifically on what occupation-al therapists need to know about working with clientswith human immunodeficiency virus (HIV)/acquiredimmunodeficiency syndrome (AIDS). Watch for parttwo of the article in the March edition of OT Now!

Why HIV and rehabilitation? Let’s begin this discussion with a brief outline of whyrehabilitation professionals (including occupationaltherapists) should be interested in exploring theirroles with clients living with HIV/AIDS. To begin with,due to the use of antiretroviral medications, HIV isincreasingly becoming an chronic illness in developedcountries instead of a death sentence. Individualsmay be experiencing the long-term health-relatedconsequences of HIV and/or the potentially adverseeffects of treatment. A recent survey documented aremarkably high prevalence of disablement amongindividuals living with HIV in British Columbia (Ruschet al., 2004). Despite the role rehabilitation profes-sionals have to play in the care and treatment of persons living with HIV, only a minority of these professionals currently serve this population(Worthington et al., 2005). In response to this gap,there is a need for increased information and education for rehabilitation professionals on the role of rehabilitation in the context of HIV and a need for more collaborative practice among health careprofessionals to better meet the rehabilitation needsof people living with HIV.

CWGHR is a national, multi-sector, not-for-prof-it, working group formed in 1998. Its primary objec-tive is to address rehabilitation issues in the contextof HIV and is centred on the needs of people livingwith HIV. CWGHR develops rehabilitation programsand resources for people living with HIV and hasdemonstrated innovation and excellence in the fieldof episodic disabilities. It aims to generate awareness

of and access to rehabilitation services and addressesthe needs and concerns of families, caregivers, com-munities and people living with HIV and related dis-abilities. CWGHR is currently engaged in three largescale projects related to HIV and rehabilitation.

1. Interprofessional Learning Project:The purpose of this project is to increase the capacityof rehabilitation professionals to respond to the rehabilitation needs of people living with HIV/AIDS inCanada. The objectives of this project include the following: develop new and enhanced existing knowl-edge-based relationships; increase awareness ofexisting and new curriculum resources, educationalinitiatives, programs and tools; and increase knowl-edge and skills related to HIV among rehabilitationprofessionals.

Through this project, an interdisciplinary educa-tion curriculum has been developed and pilot testedin three Canadian cities. Some of the key learningthat has occurred through this curriculum develop-ment is the importance of utilizing community-basedpartnerships to support and to facilitate persons liv-ing with HIV as co-faculty participants, the integra-tion of principles of interprofessional and case-basedlearning and the need to address sensitive practice inthe context of rehabilitation and HIV. Interventionstrategies for HIV related rehabilitation have beenfurther explored and ongoing evaluation has takenplace throughout the initiative. Future initiatives willinvolve pursuit of curriculum accreditation, dissemi-nation of curriculum resources and opportunities forintegrating curriculum into existing health and socialcare educational programs.

2. Episodic Disabilities Project:This innovative project has positioned HIV as anepisodic disability and has brought together a num-ber of groups interested in working together onissues of common concern. One such issue is labourforce participation. The unpredictable nature of HIVand other episodic disabilities, such as multiple scle-rosis, mental illness and cancer can present chal-lenges to active labour force participation, stable

Canadian Working Group on HIV and Rehabilitation:Involvement and opportunities for occupational therapists

Deb Cameron, Todd Tran and Gillian Bone


income and social inclusion as fluctuations occur in aperson’s ability to participate in the labour force.Disability workplace and income support policies andprograms may be well designed for people who canno longer take part in the labour force but do not

meet the needs of those whoparticipate episodically.

Based on key guidingquestions developed by a multi-sectoral national advisory com-mittee, an international policyanalysis was conducted andmodel recommendations weredeveloped. As part of this proj-ect, a national survey was con-ducted with Certified HumanResource Professionals (n=482)regarding knowledge level andneed for training in the areas ofepisodic disabilities. An eco-nomic assessment of a moreflexible hypothetical CanadianPension Plan/Disability (CPP/D)benefit program to allow dis-abled people who resume workto retain a portion of theirCPP/D benefits was carried out.Based on these findings, plan-ning for pilot sites to imple-ment the proposed model hascommenced and will begin in2007, dependent on the fundingfor pilot site activity.

3. Collaboration with theInternational Centre forDisability and Rehabilitation(ICDR) and the CameroonBaptist Convention HealthBoard:This project will develop pro-grams integrating the areas ofrehabilitation, disability andHIV with a focus on gender andstigma as they impact the lives

of people living with or vulnerable to HIV. Throughcollaboration with the ICDR at the University ofToronto and the health board in North West Province,Cameroon, West Africa, the collective expertise of thepartners will be utilized to develop resources andknowledge through reciprocal education sessions.

These sessions aim to bridge traditionally separateworlds and build capacity in issues related to gender,disability, rehabilitation and HIV.

How is occupational therapy involved withCWGHR?The varied activities of CWGHR have offered occupa-tional therapists a number of ways to get involved inthese exciting initiatives. The Canadian Associationof Occupational Therapists (CAOT) representative,Todd Tran, participates as an organizational represen-tative member of CWGHR. CWGHR membership isunique as it brings together rehabilitation profes-sionals, people living with HIV/AIDS, and representa-tives of HIV/AIDS organizations, government agenciesand human resource professionals. The CAOT repre-sentative attends CWGHR’s annual meetings to col-laborate, discuss and disseminate information withothers from various disciplines and sectors. Todd alsoreports to CAOT and this increased awareness allowsthe association to respond to some of the emergingtrends of rehabilitation for people living with HIV andAIDS. Through this collaborative effort, CAOT mem-bers will have increased awareness and insight inorder to respond to the rehabilitation needs of peopleliving with HIV/AIDS. This is done with support fromCAOT staff members Darene Toal-Sullivan, Kathy vanBenthem and CAOT executive director Claudia vonZweck who have assisted with transfer of knowledge,communication with members and letters of supportfor proposals.

In addition to the more formal CAOT represen-tative, CWGHR will be developing its membershipstructure to create further opportunities for otheroccupational therapists to join the group and sharetheir experiences and expertise. Occupational thera-pists working not only in the area of HIV/AIDS butalso with other episodic disabilities may be interestedin learning from and collaborating with CWGHR.Opportunities for students to become involved willalso be explored. By gaining strength in numbers,occupational therapists can develop best practicesand expand services to this emerging population liv-ing with HIV/AIDS.

The major initiatives undertaken by CWGHRhave also offered opportunities for the involvementof occupational therapists. Deb Cameron has beenthe CAOT representative on the InterprofessionalLearning Project. As part of the advisory committeeto this project, she has had the opportunity to assistin the development of curriculum related to HIV and


About the authors – Deb Cameron is anassistant professorand internationalfieldwork coordinatorin the Department ofOccupational Scienceand OccupationalTherapy at the Univer-sity of Toronto. Deb isthe CAOT representa-tive on the ProjectAdvisory Committeefor the InterprofessionalLearning in Rehabilit-ation in the Contextof HIV Project. You can e-mail Deb at deb.cam-eron @utoronto.caTodd Tran is an occu-pational therapistworking at the NewWomen’s CollegeHospital and in thecommunity with COTAas a consultant at CaseyHouse, which provideshospice and palliativecare for clients with HIVand AIDS. Todd is theCAOT representative onCWGHR.Gillian Bone is a physiotherapist andproject coordinator ofthe InterprofessionalLearning in Rehabilit-ation in the Context ofHIV - CapacityBuilding Project,Canadian WorkingGroup on HIV andRehabilitation.

rehabilitation and serve as a co-faculty member forone of the interprofessional education sessions.Through this role, Deb has also had the opportunityto co-author a number of posters and presentationswhich have shared this project at occupational thera-py, physical therapy and HIV professional nationaland international conferences.

The Cameroon/CWGHR/ICDR project has offeredan opportunity for Lynn Cockburn, a faculty memberat the University of Toronto and ICDR associate, toprovide research and clinical expertise to this emerg-ing project. Other rehabilitation professionals havethe opportunity to work with CWGHR on researchprojects related to HIV and rehabilitation: MurielWestmoreland (who was an occupational therapyfaculty member at McMaster University when theproject originated but is now retired from McMasterUniversity) is on the Advisory Committee for the

Episodic Disabilities project; Sheila Thomas, an occu-pational therapist from St. Michael’s HIV team, hasbeen involved in several projects and committees andCarolyn Gruchy from Alberta was the representativefor CAOT before Todd Tran. To find out more aboutCWGHR and the current projects and initiatives visitwww.hivandrehab.ca

ReferencesRusch, M., Nixon, S., Schilder, A., Braitstein, P., Chan, K., & Hogg, R.S.

(2004). Impairments, activity limitations and participa-tion restrictions: Prevalence and associations among per-sons living with HIV/AIDS in British Columbia. HealthRelated Quality of Life Outcomes,2,46. Retrieved November10, 2006 from http://www.hqlo.com/content/2/1/46.(doi:10.1186/1477-7525-2-46)

Worthington, C.,Myers,T., Cockerill, R., Nixon, S., O'Brien, K., & Bereket,T. (2005). HIV and Rehabilitation: Canadian providers' surveyof rehabilitation professionals' perspectives. Fact sheet avail-able at http://www.hivandrehab.ca/dc/dc.htm


Stable, Able and Strong is a support program for olderadults who have experienced a fall. The goal of theproject is to enable older adults to maintain orresume engagement in meaningful activities athome and in the community. This post-fall supportprogram will address the following areas:

• Fear of falling.• Personal, environmental and activity-related risk

factors for subsequent falls.• Strategies to safely resume daily occupations.

Stable, Able and Strong uses a communitydevelopment model to guide the program and willprovide training for local older adult volunteers tobecome peer mentors. These mentors will work withcommunity dwelling older adults who have fallen tohelp them to identify their fall risks and set goals toresume meaningful activities. The peer mentors willenable older adults to connect with existing medical,social service and community services that can helpthem meet their goals. If gaps in local services areidentified, the local site coordinator and peer mentorscan draw on a collection of resources to develop specific modules to meet clients’ needs.

To date the national project team has been con-centrating on the development of on-line and printedmaterials including a program manual, peer mentortraining manual and database of fall prevention andpost-fall resources. These tools build on existingHealth Canada and non-governmental organizationresources, as well as resources that were developed ina previous CAOT and University of Ottawa project, Toolsfor Living Well. The Tools for Living Well resources areavailable for download at www.otworks.ca. The newStable, Able and Strong resources will also be availablefollowing testing and feedback from older adultswhich will be incorporated into the final version.

Stable, Able and Strong is excited to announcethe implementation phase of the pilot projects. Theprojects began this past August in Calgary andCharlottetown and in September in the Ottawa-Gatineau area. We would like to introduce our threesite coordinators:

Calgary: Margaret UsherwoodMargaret has a background in nursingand has recently been contracted forprojects dealing with health promo-tion for seniors and seniors housing.She was the Calgary coordinator forthe Tools for Living Well project and

brings over 10 years experience in home care andproject management experience. Margaret is wellnetworked within the Calgary business, medical andhousing communities and is a member of severalrelated boards and committees. She looks forward toworking with the team and brings enthusiasm, aswell as a keen interest to the project.

Ottawa-Gatineau: Una Choi Una graduated from the occupa-tional therapy program at theUniversity of Ottawa in 1992. Shehas travelled extensively, working asan occupational therapist in severaldifferent countries. She now has aprivate practice clinic in Gatineau,

Quebec and also practices in the Ottawa area. Unahas a growing interest in community-based occupa-tional therapy and its links with hospital-based practice as well as other community organizations.She hopes that this pilot project will highlightexisting resources and create new and sustainablelinks within the community.

Charlottetown: Marie BrineMarie graduated from the occupa-tional therapy program at DalhousieUniversity in 1985. Throughout hercareer, she has taken an active interest in injury prevention, as wellas linking individuals with their communities to improve well being.

She presently has her own private practice and hasmany connections throughout Charlottetown andPrince Edward Island. In 2003, Marie was the site coor-dinator for Prince Edward Island for the falls preventionproject Tools for Living Well. She is excited to work withthe Charlottetown community to build on previousgains achieved through the Tools for Living Well project.

For more information about the Stable, Ableand Strong Project, please visit www.otworks.ca andwatch for further updates in OT Now as our work progresses at the three pilot sites.

Stable, Able and Strong is a three year pilot projectsponsored jointly by the Canadian Association ofOccupational Therapists and the University of Ottawa,Occupational Therapy Program. The project is fundedby the Population Health Fund, Health Canada fromSeptember 2005 to June 2008.

Stable, Able and Strong Project:Meet our site coordinators


Insightful speakers, pertinent new publications andinformative pre-conference workshops are what you willfind when you join us in the stunning city of St. John’sfor Conference 2007 from July 11 to 14, 2007. Our themethis year is “Leading the way to healthy occupation”.

Keynote speakerAs a leader of change and innovation, Sister ElizabethDavis has created, guided and inspired many healthcare professionals. You will have an opportunity tohear this dynamic speaker in her keynote address forConference 2007.

Sister Elizabeth Davis is not only grounded by her20 years of experience working in health care, but also byher spirituality as a member of the Congregation of theSisters of Mercy of Newfoundland and Labrador. Shecombines both of these elements in her work which hasincluded serving as the executive director of St.Clare’sMercy Hospital and leading the creation of the HealthCare Corporation - both in St.John’s.This corporation is aregional health board combining eight teaching hospi-tals and health centres, a nursing school and a regionalambulance service.

As a doctoral student in Scripture at the TorontoSchool of Theology at the University of Toronto, SisterElizabeth Davis continues on the path of lifelonglearning while also sharing her knowledge throughteaching at St. Augustine’s Seminar. Her passion forreforming and transforming health care continuesthrough ongoing leadership roles as chair of theCanadian Health Services Research Foundation, vice-president of the Medical Council of Canada, andboard member of the Royal College of Physicians andSurgeons of Canada. Her outstanding contributionsto Canadian society have been recognized by herrecent award of an Order of Canada.

Enabling Occupation 2007 Join your colleagues for the launch of Canada’snewest landmark publication of occupational therapypractice guidelines, a new companion book to EnablingOccupation 1997/2002. Since the publication of the1997/2002 practice guidelines, enabling occupationhas become a term used worldwide to describe occu-pation-based, client-centred enablement. Dr. Elizabeth

Townsend will lead a special plenary session at theconference to open dialogue and launch this publica-tion. Comprised of views on enabling occupationfrom national contributors, this exciting new publica-tion promises to be a truly Canadian book that willlead occupational therapy in the future.

Pre-conference workshopsFour instructive pre-conference workshops will beoffered from July 9 to 11, 2007.

1. The ADL Profile is a three-day workshop for participants to become familiar with the evalu-ation tool, its theoretical basis and the applica-tion of the tool in clinical practice. Presentersare Carolina Bottari and Élisabeth Dutil.

2. Pressure management: A team approach is aworkshop targeted for occupational therapists,physical therapists, nurses, dieticians and ven-dors who want to develop a team approach forthe prevention and treatment of pressureulcers. Presenter is Linda Norton.

3. A one-day private practice forum will be offeredto focus on “hot topics” important to occupa-tional therapists working in private practice.This forum will address best practices, ethics,fee setting, improving practice by learning fromour mistakes and access for coverage throughextended health insurance. Small group sessions will enable networking and the

Plan to attend the CAOT Conference 2007 in St. John’s, Newfoundland and Labrador

Tanya Baglole, CAOT Communications Coordinator


Photo courtesy of Newfoundland and Labrador Tourism

application of new knowledge. Facilitators areSusan Swanson and Lorraine Mischuk.

4. A one-day workshop will be held on facilitating successful return to work with clients experiencingdepression, anxiety or post-traumatic stress disorder.Participants of this interactive workshop will learnabout and practice strategies to help facilitate successful return to work. Findings will be presentedfrom a two-year qualitative research study.Participants will work collaboratively with presen-ters through several case examples to determinebest practice for return to work concerns. Learningwill also take place through the observation ofvideotaped interviews of actual clients dealing withissues related to return to work. Presenters areJocelyn Cowls and Edith Galloway.

Muriel Driver Memorial Lectureship Award Dr. Mary Egan is the Muriel Driver Memorial Lecturer

Located on CAOT’s web site in the members’ only sec-tion, you will find the Information Gateway offeringpractical resources for your evidence-based practice(EBP). Since evidence by nature evolves, the Infor-mation Gateway is updated regularly to ensure CAOTmembers have access to the latest and most perti-nent EBP resources. These resources include access todatabases and networks exclusive to CAOT members,as well as information available in the public domain.

The Information Gateway home page providesquick links to basic information you will need to getstarted, such as an article on why we use evidence inpractice and the Joint Position Statement on Evidence-based Occupational Therapy (Canadian Association ofOccupational Therapists [CAOT], Association ofCanadian Occupational Therapy University Programs[ACOTUP], Association of Canadian OccupationalTherapy Regulatory Organizations [ACOTRO] andPresidents' Advisory Committee [PAC], 1999), a greatresource when implementing an EBP, Best Practice orJournal Club at work. You will also find informationon how CAOT is creating an EBP culture by fundingprojects and providing workshops for members

across Canada.In order to become familiar with many of the

Information Gateway’s resources, let’s walk through asearch vignette together.

Occupational therapist Leslie has been asked toprovide her practice leader with evidence to evaluatethe impact of an energy conservation program fortheir rehabilitation department’s expanding multiple

Information Gateway: Where CAOT members go to find the evidence they need

Kathy Van Benthem, CAOT Professional Education Manager


for 2007, winner of the most prestigious CAOT award.In the 24 years of her occupational therapy career, Dr.Egan has made and continues to make a substantialcontribution to occupational therapy research, educa-tion and teaching. Dr. Egan is well-known for herwork incorporating spirituality and occupationaltherapy. She has also made significant contributionsto rational care through her research on evidence-based occupational therapy. Her work has led tomethods for considering empirical and qualitativeresearch evidence throughout the occupational ther-apy process.

Conference 2007 promises to be an experiencethat leaves you enriched by knowledge and revital-ized through participation and networking at bothprofessional and social events. We hope you will joinus in “Leading the way to healthy occupation” in St. John’s, Newfoundland and Labrador this summer.

sclerosis therapy service. Leslie has three hours ofresearch time and begins her search with the CAOTInformation Gateway.

Step one:

The Information Gateway is accessed quickly from thewww.caot.ca home page in the Members’ Only Area.Begin a search by selecting the Tools and Resourceslink to access numerous databases, including collec-tions of journals and articles (some with full-textoptions, and networking opportunities). The links inthe Tools and Resources are arranged in the order ofthe steps integral to pursuing evidence-based prac-tice (Craik & Rappolt, 2003). The steps described byCraik and Rappolt (2003) include choosing a modelfor research utilization, identifying the issues (includ-ing the development of an EBP question), searchingthe evidence, consulting with others, critical appraisaland disseminating the evidence.

Step two:

In this case, Leslie does not need to review Choosing aModel; however, she must define her EBP question, soshe proceeds to the Identifying the Issue(s) link. Byassessing the resources from the recently launchedOT Evidence link, Leslie discovers that to search mostefficiently, she should include details of the client,health issue, intervention and outcomes in her searchparameters.

Leslie decides to use the following EBP question:“Are there occupational performance benefits withthe participation in an energy conservation programfor individuals with multiple sclerosis?” This questiontakes into account the majority of their clients andimportant intended outcomes of the intervention.

Step three:Leslie proceeds directly to Searching the Evidence asshe knows there are many databases located herethat may answer her EBP question. She has alsolearned that systematic reviews can provide strongevidence, so she scrolls to the bottom of the page andbegins her search with OT Seeker and the CochraneCollection. Leslie finds one relevant systematic reviewwith links to the abstracts (Steultjens et al., 2006). Tofind more specific articles, she clicks on OTDBASE,which is accessed for free by CAOT members. TheOTDBASE is a database of numerous occupationaltherapy journals from around the world. As a CAOTmember, Leslie can immediately access, at no charge,all available CJOT and OT Now articles online that theOTDBASE search finds. By typing in a few key words ofher search question, Leslie finds a reference to a rele-vant article with the abstract provided.

CAOT’s OT Education Finder is another way thatCJOT and OT Now articles can be located. Available toall visitors of CAOT’s web site as well as through theInformation Gateway, the OT Education Finder canalso be used to find and post educational resources.Leslie can find the full text articles of several othercitations she discovers by visiting her hospital or localhealth sciences library or by using the CAOTLiterature Search Service.

More evidence may be found by connecting withother CAOT members across Canada. This may seemdaunting, like finding a needle in a haystack, but withthe CAOT Network Exchange, the task is made simple.To do this, Leslie returns to the Tools and Resourcespage and clicks on the Consulting with Others link.This page will connect you to the CAOT NetworkExchange. Leslie uses easy search parameters to con-tact other CAOT members working with similar clients


in similar practice settings. She selects a few namesand e-mails and then puts out a request for evidenceon her topic. This may provide her with resources andevidence found by others on similar searches.

Before submitting her stack of evidence to herpractice leader, Leslie critiques the evidence withresources from the Critical Appraisal link. She chooses the McMaster Centre for Evidence-basedRehabilitation Review Guidelines for quantitativeresearch (Law et al., 1988) to assure herself that theresources she found will stand up under scrutiny.

Step four:A few days later, Leslie has completed the researchand provides her practice leader with numerous evi-dence-based resources that answer her original ques-tion. One of the studies is particularly useful andseems to contain new and valuable evidence. As thelast step in the process, Leslie suggests to her practiceleader that the occupational therapists in their serv-ice collaborate at the next few Journal Club lunchesto develop a Critically Appraised Paper (CAP) on thisstudy for submission to the CAP’s editor of OT Now(See page 17 of this issue for an example of a CAP onthe effectiveness and efficacy of an energy conserva-tion course for people with multiple sclerosis).Disseminating the Evidence is the last step on theInformation Gateway Tools and Resources page. Thiscrucial step of knowledge exchange is central to thegoal of the Information Gateway: enabling our mem-bers in their pursuit of an evidence-based practice.


(L to R): Adeena Wisenthal, Sharon Fotheringham, Donna Campbell, Paulette Guitard,Claudia von Zweck, Danielle Massicotte and Jean-Pascal Beaudoin.

CAOT's executive director,

Dr. Claudia von Zweck,

attained her PhD in

Rehabilitation Science from

Queen's University in

October 2006. Ottawa area

CAOT members, stakehold-

ers and staff celebrated her

graduation at the National

Office in Ottawa during a

breakfast gathering.

CAOT is pleased to offer many EBP resources onthe Information Gateway that are current and rele-vant to your practice. By using the resources andsharing your results with other occupational thera-pists, we all support an EBP culture, which benefitsour profession and our clients. As a member of CAOTyou have free access to:

• OTDBASE• CAOT Network Exchange• CAOT Resource Sheets• CAOT Online Toolkits• Critically Appraised Papers• CAOT Hot Topics• Full-text of available OT Now and CJOT articles.

ReferencesCraik, J., & Rappolt, S. (2003). Theory of research utilization

enhancement: A model for occupational therapy.Canadian Journal of Occupational Therapy, 70, 266-275.

Canadian Association of Occupational Therapists (CAOT),Association of Canadian Occupational Therapy UniversityPrograms (ACOTUP), Association of CanadianOccupational Therapy Regulatory Organizations (ACOTRO)and Presidents' Advisory Committee (PAC), 1991. JointPosition Statement on Evidence-based OccupationalTherapy. Retrieved September 29, 2006, fromhttp://www.caot.ca/default.asp?ChangeID=166&pageID=156

Law, M., Stewart, D., Pollock, N., Letts, L., Bosch, J., & Westmorland,M. (1998). Critical Review Form – Quantitative Studies.Retreived November 23, 2006, from http://www.fhs.mcmaster.ca/rehab/ebp/

Steultjens, E.M.J., Dekker, J., Bouter, L.M., Cardol M., Van de Nes,J.C.M., & Van den Ende, C.H.M. (2006). Occupational therapy for multiple sclerosis – Cochrane Review.Retrieved October 10, 2006, from http://www.cochrane.org/reviews/en/ab003608.html

In a society in which our identity is often tied to whatwe do, the pursuit of meaningful leisure occupationscan be very important in establishing a sense of self.Individuals living with a serious and persistent men-tal illness feel that their illness encompasses their lifeand identity. They start questioning their ability to domany of their past occupations including productivework and schooling. Re-engaging in past occupationsor discovering new occupations can provide the per-son with a sense of identity, purpose, pleasure,accomplishment and mastery, as well as feelings ofnormalcy. All occupations, including leisure, provide

structure to the day, something that is often missingin the everyday lives of individuals with mental ill-ness. Leisure can be defined as occupations “whichproduce intrinsic rewards and provide the participantwith life-enhancing meaning and sense of pleasure”(Reid, 1995, p. 14). The individual judges his or her lifeimportance by the activity (Reid, 1995). Pursuingleisure is a safe venue for persons to re-engage indoing, to start down the road towards recovery.

Taking the time to listen to our clients’ occupa-tional stories in an era of time constraints and wait-lists within an overtaxed health care system is a chal-lenge for occupational therapists. However, enablingour clients to choose leisure occupations that are sig-nificant to their lives provides them with a sense ofchoice and control. We need to ensure that we do notimpose our preconceived ideas onto our clients’ occu-pational goals. The goal of this article is to show howlistening to our clients’ occupational stories andenabling them to pursue their desired occupationscan significantly affect many aspects of their lives.

Daphne*, in her 60s, a gardenerDaphne is a creative individual who has a passion forhome décor and gardening and does arts and crafts.After her husband died 2 years ago, she decided toremain in her rural home, alone, as she was not quiteready to move into a retirement residence. Daphne

has a mood disorder, as well as arthritis, the latterhaving limited her physical activities, especially herability to garden. She has always taken pride in hergreen thumb, however, while dealing with her illness-es over the past couple of years she has neglected hergarden, which has become a refuge for weeds. When Imet Daphne she voiced a great desire to restore hergarden to its former glory. Our initial discussionfocused on how Daphne could be an active gardenerbut in a different way than she had been before. Sheresigned herself to the fact that she was not as physi-cally fit as she once was and determined that shewould be able to enjoy her gardening more if sheenlisted help. We discussed how she could stillengage in gardening, but that some of her engage-ment would involve less physically demanding taskssuch as planning, purchasing, delegating and plant-ing planters.

Once Daphne had an image of how she couldstill garden, she quickly organized herself with land-scaping designs, a new patio set, planters and weed-killing regime. She was in control of her gardeningusing others to help her with what she would like toaccomplish. Daphne hired a neighbour to take care ofher lawn and the heavy garden work. Her grandsonvisited her often, and he helped her transport theheavy gardening materials out of her car to the gar-den. I was delighted to see the beautifying progresswith each successive visit and to see Daphne proudlysharing her accomplishment as we toured her gar-den. She recently purchased a beautiful decorativewaterfall for her garden and already has plans fornext year that involves restoring her back gardenfrom weed haven to garden paradise. This occupa-tional interdependence has allowed Daphne to re-engage in a meaningful occupation, providing herwith a sense of control over her home and surround-ings and restoring some of the identity she had lost.

Re-capturing an important piece of self through leisure occupations


SENSE OF DOI NG

“...enabling our clients to choose leisure occupations thatare significant to their lives provides them with a sense ofchoice and control.”

Susan Yee

Edited by Polatajko and Davis, on behalf of CSOS.Visit CSOS at www.dal.ca/~csos/index.htm

Column Editors: Helene J. Polatajko and Jane A. Davis

Ned*, in his late 20s, a hockey playerNed lives in a small town with his parents. He cur-rently has a part-time job as a store clerk and receivesa disability pension. As a teenager, Ned was an activehockey player and played on the all-star team. Heenjoyed the physical activity as well as the cama-raderie of playing on a team. In his late teens Nedwas diagnosed with schizophrenia, which increasinglykept him from playing hockey. For the first year afterdiagnosis, Ned did not leave his home, having hisfamily take care of him. Later he played in a non-competitive hockey league for a while until his unclewas no longer able to accompany him to the games.He did not always have access to a vehicle and feltuncomfortable driving at night. Now, he avoids newsituations as he finds them very stressful. When I metNed, he told me that he wanted to get back into play-ing hockey again, as he missed the game. To becomereconditioned, Ned and I began to ice skate at thenew local arena. Some days there were few peoplepresent, so he was able to do some of the hockey drillshe did as a teenager. He zipped around the rink,skating in short spurts with quick stopping. Heenjoyed the feeling of skating and doing familiarmovements.

A male occupational therapy student on a field-work placement at the community agency providedNed with the support he needed to get him back intoplaying hockey at the local arena. Ned was delightedwith the prospect of playing hockey once again andwaited anxiously for the student to begin his field-work placement. Although he did not know the stu-dent prior to re-engaging in hockey, Ned felt morecomfortable having someone accompany him to theweekly 8 a.m. pick-up games. Ned also felt comfort-

able interacting with the malestudent, who was close to hisown age, and was able to speakwith him about many differenttopics. Engagement in hockeyprovided structure to Ned’smorning. Before he didn’t wakeup until late morning but whilehe was playing hockey he regu-

larly was up early, ready to play hockey. More impor-tantly, playing hockey provided Ned with a sense thatrecovery is possible and has led him to think moreabout his future and reconsidering forgotten dreams.Ned chose not to continue with hockey after the stu-dent left, however he has mentioned that he wouldlike to start again this fall.

James* and Marshall*, in their 40s, the creative writersThe community agency where I work began a weeklyarts and crafts group to meet the leisure needs of ourclients. We hoped this group would provide a sup-portive environment for group members to re-engagein old, or to learn new, creative occupations, including

artwork, crafts and creative writing. Over time, thegroup members decided to focus predominantly oncreative writing occupations, such as writing shortstories and poems, and encouraged each other tosubmit their prose, poetry and short stories to maga-zines and to critique each other’s work. After a fewmonths they decided that they wanted to be editorsof an anthology of poetry, prose, short stories and art-work on the theme of recovery. The changes in thegroup members, especially James and Marshall, weretremendous.

James had always had a passion for horror andscience fiction movies and books. For a long time hehad the plot planned out and characters developed fora sci-fi short story but his quest for perfection hadprevented him from finalizing the story and printingit out for others to read. James enrolled in an Englishclass through the local school board, which helpedhim with his story’s content development. The safeand creative nature of the group and its expectationto create a written product enabled James to com-plete the short story he had been formulating in hishead for years.

Marshall grew up in a cloistered communityand discovered his gift of writing poetry when hemoved to town several years ago. He enjoys rhymingin his poetry. Some of his poems are whimsical andfunny while others are reflective and introspective; hehas submitted a few to a magazine for publication.

James and Marshall became the editors of theanthology, with support from Meredith, a social serv-ice worker, and myself. With James and Marshall aseditors, the group sought submissions for the antholo-gy from other clients of the agency and decided thecriteria for acceptance. The anthology was launchedduring Mental Health Week with an open house at thePeer Support Office. The writers of the anthology readexcerpts of their writing during the open house withJames and another member being the masters of cer-emony. James and Marshall were able to facilitate


About the author – Susan Yee is an occupational therapistworking in the area of mental health inOntario. She can bereached [email protected]

“This recovery involves the restructuring of the occupational lives of individuals living with mental illness...”

their own and other clients’ creative occupations,enabling them to develop their talents and to sharetheir experiences of recovery. Through this creativegroup, James and Marshall developed a sense ofaccomplishment and purpose. Being the editors ofthe anthology provided them with a sense of control,and they were enabled to achieve mastery through itspublication.

These real life stories demonstrate how engag-ing in leisure occupations can offer individuals livingwith a serious and persistent mental illness a senseof control, especially when they feel that their illnessand clinicians drive their lives. Recovery involvesremembering who you were and re-engaging in pastsignificant occupations, which although done differ-ently, are still significant and achievable. For Daphne,Ned, James and Marshall their leisure occupationsprovided structure to their lives, and gave them a senseof purpose. They increased their social networks and

were able to show their skills and their talents. Livingwith a mental illness requires great occupationaladaptation; occupational therapists can play a keyrole in enabling that adaptation, in vanquishing thebelief that all aspirations vanish because of mentalillness, and in demonstrating that recovery is possi-ble. This recovery involves the restructuring of theoccupational lives of individuals living with mentalillness, to enable them to engage in important andsignificant occupations including leisure. In a goodenvironment, our occupational accomplishments arelimitless.

* The names and information were changed to ensure confidentiality.

ReferenceReid, D. G. (1995). Work and leisure in the 21st century: From

production to citizenship. Toronto, ON: Wall andEmerson.


February 1 deadline approaching for nominations

Awards - CAOT invites members to nominate worthy colleagues for the following awards:• Muriel Driver Memorial Lectureship Award• Fellowship Award• CAOT Life and Honorary Membership• Dr. Helen P. LeVesconte Award for Volunteerism in the Canadian Association of Occupational Therapists• CAOT Award for Innovative Practice• CAOT Award for Leadership in Occupational Therapy• CAOT Award of Merit• Citation Award

Board of Directors - CAOT is seeking occupational therapists to provide national representation andleadership in professional issues to Canadian occupational therapists. Opportunities are available forthe following positions:

• President Elect• Secretary/Treasurer• Directors to the Board from British Columbia, Alberta, New Brunswick , Nova Scotia, Newfoundland/

Labrador and Yukon/Northwest Territories/Nunavut.

The deadline for the call for nominations is February 1, 2007.Visit www.caot.ca for details or contact:

CAOT National OfficeCTTC Building, 3400-1125 Colonel By DriveOttawa, ON K1S 5R1Tel.: (800) 434-2268, ext.228 Fax: (613) 523-2552E-mail: [email protected]

Dr. Marcia Finlayson becamemanaging editor of the Can-adian Journal of OccupationalTherapy (CJOT) in May 2006.She brings much expertise to herrole. Marcia is associate professorin the Department of Occupa-tional Therapy, University ofIllinois in Chicago. She receivedher Bachelor’s degree in occupa-tional therapy and her Master ofScience and Doctorate in Com-munity Health Sciences from theUniversity of Manitoba inWinnipeg. Marcia has been amember of the CJOT Review Boardsince 1999 and previously workedwith CAOT as a project coordinatorfor the Seniors’Health PromotionProject in Manitoba.

Tanya Baglole became the CAOTcommunications coordinator inSeptember 2005. She reported forthe Toronto Star newspaper andCanadian Press, and has workedin communications for variousorganizations, including theCanadian Psychiatric Associationand Canada’s Research-BasedPharmaceutical Companies. Tanyaearned a Bachelor of Applied Artsin Journalism from RyersonPolytechnic University and alsoholds a Bachelor of Arts, with amajor in English, from theUniversity of Manitoba.

Jenny Turner began a permanent staff position atCAOT as business administratorin October 2006. She has worked in finance for the past six years.

Fern Swedlove, the former CJOTeditor, assumed the helm asmanaging editor of OccupationalTherapy Now (OT Now) in April2006. Fern brings many years ofexperience to the position ofmanaging editor. After graduat-ing as an occupational therapistin 1979 from McGill University inMontreal, she worked for 20years as an occupational thera-pist before returning to schoolto earn a communications diploma at Red River College inWinnipeg. She became the editor of CJOT in August 2001and is currently working on her Master's of Science inRehabilitation degree at theUniversity of Manitoba inWinnipeg.

Linda Charney joined CAOT as apermanent staff member inOctober 2006 as publicationsassistant. She has over 20 yearsexperience in client relations,including working for the Heartand Stroke Foundation of Ontario.

Lisa Barthelette joined CAOT as finance manager in October2006. She previously worked inthe property managementindustry as well as for a not-for-profit charitable organization.She earned a Bachelor ofCommerce degree from CarletonUniversity and attained her certified general accountantdesignation in 2002.

Staff changes at the CAOT NationalOffice



Meetings with the University of Saskatchewanand provincial governmentRepresentatives of the Canadian Association ofOccupational Therapists (CAOT) and the SaskatchewanSociety of Occupational Therapists (SSOT) met inRegina with officials from the University ofSaskatchewan and the provincial government in lateNovember to promote access to occupational therapyservices in the western province. Meetings were heldwith the University Provost, Dean of Medicine andAssociate Dean of the Interdisciplinary Team Program onNovember 22, 2006 and the Saskatchewan Minister ofHealth and the Minister of Advanced Education andEmployment on the following day. Following the meet-ings, both university and government officials said theywere committed to working collaboratively with CAOTand SSOT to address access issues to benefit theSaskatchewan population.

CAOT board of directors meeting The CAOT board of directors gathered for a two-daymeeting, which began November 24, 2006 inSaskatchewan’s capital city. The board meeting waspreceded by a board orientation and evaluation.Highlights of the board meeting included:

• Funding approval to provide an educational session for the Canadian Framework for EthicalOccupational Therapy Practice.

• Funding approval to develop a supportpersonnel competency profile.

• Working with the physiotherapy profession todevelop accreditation guidelines for occupationaltherapy support personnel education.A number of policy changes were approved to

help implement the strategic plan of the CanadianJournal of Occupational Therapy (CJOT). Policies forCJOT were approved on the following topics: keywords, review board, editorial statement, ad hocreviewers, ethical statement, review process, disposi-tion of submitted manuscripts, copyediting andappeals of CJOT manuscript disposition decisions.

In addition, a one-time funding approval wasprovided to increase the number of pages for the2007 volume year. This initiative is in response tomember concerns regarding the wait time for publi-

cation in CJOT. Funding was also approved for a CJOTspecial issue of the International Classification ofFunctioning, Disability and Health.Other business

• CAOT will be striking a sub-committee to reviewCAOT Bylaws.

• Minor revisions were made to strategic priori-ties for 2007-2008.

• Revised position statements were approved onthe following topics: Health and Literacy, as wellas Primary Health Care.

• Bachelor of Science in Occupational Therapy atUniversité Laval was granted a 7-year accredita-tion award from April 2006-2013.

Budget and financesThe board reviewed the unaudited financial state-ments for the 2005-2006 membership year and waspleased to note a significant excess surplus in funds,resulting from higher than anticipated attendance atConference 2006 and participation in externally fundedgrants. The favorable position of CAOT allowed theboard to fund the following new initiatives:

• One-time funding for Certification ExaminationItem Generation Board for train-the-trainer sessionsto lead item generation workshops.

• A one-time donation to WFOT.• Funding to host an interprofessional meeting on

the topic of Collaboration Client-Centred Care inFeeding, Eating and Swallowing as well asProfessional Issue Forums at Conference 2008 onAccess to Occupational Therapy Services and Drivingand Occupational Therapy: Changing Practice.

• Funding to implement initiatives mentioned aboveincluding the review and revision of CAOT By-Laws,increased publishing capacity for the CJOT in 2007with additional pages and a special issue.

• Funding for the Canadian Framework for EthicalOccupational Therapy Practice education sessionand the Support Personnel Competency Framework.The board also reviewed the first draft of the

2007-2008 operating budget. They allocated excesssurplus funds to balance a projected operatingdeficit. This was undertaken to minimize a need for amembership fee increase.

Highlights from CAOT meetings in Regina duringNovember 2006



programs have expressed interest to offer upgrad-ing courses for international graduates. Existingprograms in Quebec and Alberta can inform thedevelopment of such new programs.

5. Help international graduates connect with employ-ers, occupational therapists and professionalresources. International graduates need better support and resources, such as mentoring programs,regional professional association meetings, onlinejob listings, opportunities for job shadowing,volunteering or supervised practice and continuing education courses to successfully enter the Canadian occupational therapy workforce.

6. Advocate the need for internationally educatedoccupational therapists in Canada. Advocacy isneeded to inform government officials of the needto fast-track immigration applications of interna-tional occupational therapy graduates for regionsof Canada experiencing shortages of occupationaltherapists.

7. Promote a diverse workforce for quality occupa-tional therapy services. Internationally educatedoccupational therapists play an important role inmeeting rising demands for occupational therapyservices in Canada. In addition, they offer innova-tion and diversity needed for a flexible workforcethat can provide service to clients with differingsocial, cultural and language backgrounds.Unfortunately, the experiences reported in thisproject indicate that international graduates donot always feel welcome in Canada. The WorkforceIntegration Project report will be shared withorganizations involved with internationally edu-cated occupational therapists to encourage ongo-ing evaluation and improvement of practices andservices for international graduates.

For more information on the WorkforceIntegration Project visit www.caot.ca or contactClaudia von Zweck, CAOT Executive Director, at(800) 523-2268, ext. 224 or [email protected]

The report of the Workforce Integration Projectwill be available on the CAOT web site in early 2007.

The Workforce Integration Project was an initiative toidentify issues that enable or hinder internationalgraduates to integrate into the Canadian occupationaltherapy workforce. The project was prompted by therecognition that a significant number of individualseducated as occupational therapists in other countriesexperience difficulties with workforce integration at atime when many parts of Canada are faced with anunder-supply of occupational therapists. Funded by theGovernment of Canada Foreign Credential RecognitionProgram, the project has been led by the CAOT sinceMay 2005 and concluded in November 2006.

Based on the findings of the project, the followingrecommendations were developed in consultation withrelevant stakeholders:1. Coordinate and centralize professional registra-

tion requirements and processes. Many Canadianorganizations are involved in assessing competencyfor practice. Coordinating and centralizing require-ments and processes is necessary to make it easierand more efficient to register as an occupationaltherapist in Canada.

2. Improve the national certification examinationaccess, preparation resources and assistance withthe exam. A plain-language version of the certifica-tion examination is scheduled to be introduced byCAOT in 2007. CAOT also explored the developmentof a computer-based certification examination andis considering the development of online resourcesfor international graduates.

3. Provide clear and accessible information to helpinternational graduates to work in Canada.International graduates requested a centralizedsource of information about the stages required to immigrate and register for practice in Canada.Resources are also needed to assist internationalgraduates to understand occupational therapypractice within the context of health and social systems in Canada. CAOT has added a new section toits web site for information and resources which willlink to other organizations providing services tointernational graduates.

4. Increase opportunities for academic upgradingand language training to meet registrationrequirements. University occupational therapy

Workforce Integration Project:Final recommendations


Claudia von Zweck, CAOT Executive Director

no one was lost to follow-up. Of the 91 people allocatedto the delayed group, 69 completed the intervention,22 did not. One participant was lost to follow-up.There was a 23% attrition rate (those who did notreceive the full intervention) which was a little morethan what was expected.

Intervention: A standardized energy conservationcourse (Packer, Brink & Sauriol, 1995) was provided by12 certified occupational therapists. The course wastaught in 2 hour sessions each week for 6 weeks toaddress the importance of rest, communication, bodymechanics, ergonomic principles, environmental andactivity modifications, activity analysis, priority set-ting, changing standards and living a balanced life.Teaching methods included lectures, discussions, goalsetting, practice activities and homework assign-ments. The immediate intervention group completedthe energy conservation course during weeks 2 to 7while the delayed control group completed the ener-gy conservation course during weeks 8 to 13.

Outcome measures: The primary outcome meas-ures were the Fatigue Impact Scale (FIS) and theSF–36 Health Survey (assesses perceived health-relat-ed quality of life). Each participant completed theseat weeks 1, 7 and 13. Self-Efficacy for PerformingEnergy Conservation Strategies Assessment was usedto assess self-efficacy of each participant before andafter completing the energy conservation course.Measures were administered by research assistantswithout the course instructors present.

Main findings: At baseline, there were no significantdifferences in immediate and delayed interventionparticipants’ characteristics or in the pattern of med-ications. Medication changes throughout the studywere similar for the two groups. Data from the twogroups post intervention were pooled without need-ing to adjust for differences between the groups.Three analytic approaches were used: Intention toTreat (ITT) Likelihood, ITT Last-Observation-Carried-Forward (LOCF) (number of participants [n] = 169),and Compliers (n = 131). The compliers were the participants who attended at least 5 of 6 EC sessions.

Energy conservation course was found to reducethe impact of fatigue, improve aspects of qualityof life and increase self-efficacy in those whohave multiple sclerosis.


CRITICALLY APPRAISED PAPERS

Column Editor: Lori Letts

Summay of Mathiowetz, V. G., Finlayson, M.L., Matuska, K. M., Chen, H. Y., & Luo, P.(2005). Randomized controlled trial of anenergy conservation course for persons withmultiple sclerosis. Multiple Sclerosis, 11,592-601.Prepared by Jane Cox, CAPs Advisory Group Member

Research objectives: To assess the effectiveness andefficacy of an energy conservation course on theimpact of fatigue, quality of life, and self-efficacy forpeople with multiple sclerosis (MS).

Design: A randomized controlled trial (RCT) utilizing a cross-over design. Two groups were estab-lished by a random ordered sequence of assignment:one received the immediate intervention of the ener-gy conservation course and the second (the delayedcontrol group) had a 6-week period of no interventionprior to receiving the energy conservation course.

Setting: Groups of 7-10 participants were providedwith the education in community settings by 12 certi-fied occupational therapists.

Participants: Participants were recruited from mailinglists of two northern U.S. state chapters of the NationalMS Society between January 2002 and February 2003.Inclusion criteria included the following:

• diagnosis of multiple sclerosis;• age of 18 years or older;• functionally literate in English;• Fatigue Severity Scale (FSS) score of 4 or greater;• lived independently in the community; and• agreed to attend at least 5 of 6 sessions on

energy conservation.Participants were excluded if they had moderate

to severe cognitive impairment as assessed by theNeuropsychological Screening Battery for MultipleSclerosis.

One hundred sixty nine people were random-ized into two groups. Of the 78 people allocated tothe immediate intervention group, 62 completed theintervention (at least 5 of 6 weeks of the intervention),16 participants did not complete the intervention, and

The ITT Likelihood and ITT LOCF are statistical methodsused to address missing data (see sidebar for moredescription of the analyses).

Data analyses supported the hypothesis thatparticipants reported a statistically significant reduc-tion in fatigue impact and a statistically significantincrease in quality of life after the energy conserva-tion course compared to the delayed control. Allthree analyses found the primary outcome measurescombined (FIS and SF-36) and analyzed separately tobe statistically significant. The statistical significanceof these data were maintained after adjusting formultiple tests with the p<0.01667 for the FIS andp<0.00625 for the SF-36.

Analyses of the three subscales of the FISrevealed that all the 3 subscales of the FIS were statistically significant for the ITT Likelihood analysis,whereas the physical and social (but not cognitive)subscales were significant for the ITT LOCF and com-pliers analyses. Effect sizes were moderate to large(d=.69-.90) for the physical and social subscales, andslightly lower for the cognitive subscale, ranging from0.52-0.57.

For the analyses of the 8 SF-36 subscales, the vital-ity subscale was significant for all three analyses. TheSF-36 Role Physical was found to be statistically signifi-cant in the ITT analyses. The SF-36 Mental Health subscale was found statistically significant in the ITTLikelihood analysis. Effect sizes ranged from small forsome subscales (physical function, body pain, generalhealth, social function and role emotional), more moderate for others (role physical and mental health) to large (0.99 – 1.14) for the vitality subscale.

A significant increase in participants’ perceivedself-efficacy for performing the energy conservationstrategies following the course as compared to beforethe course was supported by all three analyses (p < 0.0001). Effect sizes were large, ranging from 1.72 to 1.92.

Authors’ conclusions: The authors concluded that thestudy supports the efficacy and effectiveness of theenergy conservation course to decrease the impact offatigue, increase self-efficacy and increase some qual-ity of life aspects for those with MS. The group andcourse format (including homework) were cited aseffective methods of supporting participants’ learn-ing, successes and problem solving.

Contact details of authors of appraised paper:Vigil G. Mathiowetz, E-mail: [email protected]


From the column editor – More on the analysisMathiowetz and his colleagues (2005) report bothintention-to-treat and per-protocol analyses in thispaper. A bit more information about both of thesetypes of analyses may help readers to interpret theresults.

Intention-to-treat analyses: In these analyses, all par-ticipants randomly allocated to either the control orintervention group are included in the comparison ofoutcomes. By including everyone who was allocatedto the intervention group, intention-to-treat analysestake into account the variations in levels of adherenceto the intervention. It is considered the gold standardapproach to analysis when the focus is on effective-ness of an intervention.

In this article, there were missing data when partici-pants in the intervention group did not attend all ofthe energy conservation sessions. To fill in the blanks,the researchers used two approaches. The first “lastobservation carried forward” means that they simplyrepeated data from the previous assessment. This isprobably the most conservative approach because if people were improving in previous visits, thisapproach would make it appear that the performanceleveled off. In the second approach they used, the“maximum likelihood method” in which data fromprevious points were used to calculate the slope andprovide a best estimate of the next data point.

Per-protocol analyses: The analyses that the authorsdescribe as “compliers only” are also often caller per-protocol analyses. These analyses focus on those par-ticipants who received what might be considered afull dose of the intervention. It allows the researchersto focus on the efficacy of the intervention, since itfocuses only on the participants who received theintervention as had been planned or intended. Resultsof per-protocol analyses tell us about the interventionwhen offered under ideal circumstances.

While it may seem a bit complex to interpret theseresults, knowing the intent of the analyses meansthat it is now possible to better understand the out-comes arising from the intervention that was offered.

For further information regarding the statistical termsin this CAPs, you can visit the following web sites:

1. From the Cochrane Glossary of Termshttp://www.cochrane.org/resources/glossary.htm2. Wikipedia Encyclopedia http://en.wikipedia.org/wiki/P-valuehttp://en.wikipedia.org/wiki/Effect_size

Commentary on Mathiowetz, V. G. et al.(2005). Randomized controlled trial of anenergy conservation course for persons withmultiple sclerosis In a 2003 Cochrane Collaboration review by EstherSteultjens and colleagues, the authors identified theurgent need for additional, well-designed research inoccupational therapy practice for persons with mul-tiple sclerosis (MS). Mathiowetz and colleagues haveprovided a valuable contribution to the limited bodyof evidence relating to occupational therapy interven-tion with these clients, where the presence of fatigueis often a significant factor that contributes to disability and diminished quality of life (McAllister &Krupp, 2005). Energy conservation training is a com-mon occupational therapy intervention but the termis non-specific and may refer to a wide range of

specific interventions. Limitedresearch has been published toassist occupational therapistsin determining if energy conser-vation intervention is helpful or what components may bebeneficial in reducing theimpact of fatigue. By evaluatinga published protocol in a scien-tifically rigourous manner, VirgilMathiowetz and his colleaguesprovide support for one specificenergy conservation interven-tion offered to people with multiple sclerosis.

The current study buildson previously published studiesthat examined the effectivenessof a 6-week course designed byPacker, Brink and Sauriol (1995)to address the management offatigue secondary to chronic ill-ness (Mathiowetz, Matuska &Murphy, 2001; Vanage,Gilbertson & Mathiowetz2003). By using a more rigorousmethodology and a larger sample size, in this study VirgilMathiowetz and his colleagueshave addressed some of the

limitations of these previous studies and provideadditional support for their initial promising results.

Methods issues:This paper reports the results of a well designed RCTwith an appropriate sample size. A placebo controlgroup was not used; however participants were randomized into immediate and delayed treatmentgroups with the delayed group serving as a control.

The intervention in this study is a publishedprotocol that involves group education, individualhomework and opportunities for group problem solv-ing and support (Packer, Brink & Sauriol, 1995). Grouptopics are presented in an appendix. Readers interest-ed in more detail regarding this energy conservationcourse can access it in the original source. Overall, itappears that the study was well designed and under-taken but there are a few methodological issues inthe study outlined below.

1. GeneralizabilityThe study population may be considered to have cer-tain characteristics that influence generalizability ofthe results to a larger population of people with mul-tiple sclerosis. The participants were volunteers whowere motivated enough to respond and commit toparticipate in a 6-week course. They were generallywell-educated and cognitively high functioning. Alarge percentage of the participants were workingfull or part-time indicating a relatively high function-al level. All participants were also recruited from largeurban centres. The authors do acknowledge thesepoints in the limitations section and suggest thatfurther research should be completed with a broaderpopulation.

2. Categorization of functional levelsThe method used to categorize the participants’ func-tional level does not provide as clear a picture of theparticipants as some readers may want. Participantswere assessed prior to enrollment in the study to cat-egorize their functional levels. The authors state thatparticipants were rated using the MS FunctionalComposite scale by completing the 25 foot walk test,Paced Auditory Serial Addition Test, and the 9 HolePeg test. The MS Functional Composite is supportedby the National MS Society’s Clinical OutcomesAssessment Task Force (Fischer, Rudick, Cutter &Reingold, 1999) and is therefore a good assessmentchoice. However it is not clear whether the subtestsidentified were the only tests used to rate the func-tional level of participants. If so, this would seem tobe a rather limited assessment of functional ability.Although limitations in the Expanded Disability


About the commentators -Jane Cox, MSc.,CHT, OT Reg. (Ont.)OccupationalTherapist, Plastic andReconstructiveSurgery, LondonHealth SciencesCentre, E-mail: [email protected] Merla, MSc.,OT Reg. (Ont.)Occupational TherapyClinical Specialist,London HealthSciences Centre,E-mail: [email protected] Dietrich,BSc.OT, OT Reg. (Ont.)OccupationalTherapist, MS ClinicLondon HealthSciences Centre,E-mail: [email protected] address forthe commentators:339 Windermere Road,London, ON, N6A 5A5

Status Scale (EDSS) (Kurtzke, 1983) are recognized, it isthe most common scale used with clients with MS(McMillan & Murphy, 2006). The addition of an EDSSrating may have assisted readers in identifying char-acteristics of the study population.

3. Information regarding medicationThe authors reviewed medication use and changesthroughout the intervention and state that there wasno indication for concern that medications may haveimpacted on the results. However, limited informa-tion about specific medications is provided.

4. Outcome measuresThe primary outcome measures (FIS and SF-36) arewell-validated and reliable measures appropriate forthe research question. The Self Efficacy for PerformingEnergy Conservation Strategies Assessment wasdeveloped and validated for this study. The use ofstrong evaluation tools is important since partici-pants could not be blinded to the purpose of theenergy conservation course or the study, and mightbe inclined to report positive results. Both the FIS andthe SF-36 address the emotional impact of fatigue onthe individual and indirectly assess the functionalimpact. However, it is unclear how the authors com-bined the scores from these two outcome measuresin their analyses, and whether there is any precedentfor combining or summing scores as they have done.While it is tempting to look at the data from thesummary scores to make conclusions about the effec-tiveness of the interventions, the subscale scores mayin fact be more meaningful. For example, it is inter-esting to note that the intervention had little effecton the Physical Function subscale score of the SF-36,while large effects were seen in the Vitality, RolePhysical and Mental Health subscales. This suggeststhat the intervention helped people to manage roleswithout necessarily changing their physical function.The Self Efficacy measure addresses how well partici-pants felt they could implement the strategies taughtin the course.

While it may be assumed that an improvementin function might accompany improvements onthese measures, this is not directly assessed. As occu-pational therapists, enabling client participation inindividually relevant occupations is of primary impor-tance and interest. In future research, it would behelpful to include a measure such as the CanadianOccupational Performance Measure (Law et al., 2005)that identifies change in both performance and satis-faction on an individual level.

5. Statistical analysesThe statistics used to analyse the data were appropri-ate. As a result of the extent of statistical analyses,including two types of intention-to-treat as well asthe compliers analyses, this section of the article wasdifficult to follow. It might have been helpful for read-ers to be told more about the characteristics of thedrop-out (non-compliers) group. While theresearchers compare the ITT and compliers group, it isdifficult to use that comparison to get a sense of thetypes of people who did not participate in the inter-vention that was designed. Discussion of characteris-tics of this group may be relevant in light of the previ-ously discussed characteristics of the study popula-tion as a whole.

Application to practice:The results of this study are encouraging and sup-portive of Mathiowetz’ earlier work on the effective-ness of energy conservation interventions for peoplewith MS. Statistically significant improvements werefound on all measures, although not all of the sub-scales had statistically significant differences. Theseresults indicate that participants identified a reduc-tion in the impact of fatigue on their daily lives andan enhanced quality of life (especially the vitality, rolephysical, and mental health subscales of the SF-36)after completing the energy conservation course.They also indicated that they felt better able to applystrategies to manage their fatigue. While improvedfatigue management, quality of life and self-efficacymay be sufficient clinical benefit, future studies couldfocus on whether participants identify improvementsin their ability to carry out meaningful and importantoccupations. It would also be of interest to knowwhether these improvements were maintained overtime. The authors do indicate that they will report fol-low-up data on their outcome measures in one year.

The use of a structured and consistent programto teach energy conservation principles to individualswith MS appears to be a worthwhile intervention.Further examination to identify those most likely tobenefit from the intervention and longer term bene-fits is warranted. However, occupational therapistsworking with persons with MS are encouraged toconsider the program developed by Packer and col-leagues (1995).


ReferencesFischer, J. S., Rudick, R. A., Cutter, G., & Reingold, S.C. (1999). The

Multiple Sclerosis Functional Composite measure(MFSC): An integrated approach to MS clinical outcomeassessment. Multiple Sclerosis, 5, 244-250.

Kurtzke, J. F. (1983). Rating neurological impairment in multiplesclerosis: An expanded disability status score (EDSS).Neurology, 33, 1442-1452.

Law, M., Baptiste, S, Carswell, A., McColl, M.A., Polatajko, H., &Pollock, N. (2005). Canadian Occupational PerformanceMeasure (4th ed.) Ottawa, ON: CAOT Publications ACE.

Mathiowetz, V., Matuska, K. M., & Murphy, M.E. (2001). Efficacy ofan energy conservation course for persons with multi-ple sclerosis. Archives of Physical Medicine andRehabilitation, 82, 449-456.

McAllister, W. S., & Krupp, L. B. (2005). Multiple sclerosis-relatedfatigue. Physical Medicine and Rehabilitation Clinics ofNorth America,16, 483-502.

McMillan, L., & Murphy, K.A. (2006). The development and vali-dation of the Impact of Multiple Sclerosis Scale and theSymptoms of Multiple Sclerosis Scale. Archives ofPhysical Medicine and Rehabilitation, 87, 832-841.

Packer, T.L., Brink, N., & Sauriol, A. (1995). Managing fatigue: Asix-week course for energy conservation. Tucson, AZ:Therapy Skill Builders.

Steultjens, E. M., Dekker, J., Bouter, L.M., Cardol, M., Van de Nes,J.C., & Van den Ende C. H. (2003). Occupational therapyfor multiple sclerosis. Cochrane Database SystemicReview, 3, CD003608.

Vanage, S. M., Gilbertson, K.K., & Mathiowetz, V. (2003). Effects ofan energy conservation course on fatigue impact forpersons with progressive multiple sclerosis. AmericanJournal of Occupational Therapy, 53, 315-323.


Discussion questions• How broadly can the results of the research be applied to people with MS that occupational

therapists typically see? How does the sample in this study compare to the population of people with MS typically seen by occupational therapists?

• As noted by the commentators, occupational performance outcomes were not measured in this study.How then can the findings of reduced fatigue and increased health-related quality of life be linkedwith occupational performance?

• Although there are methodological issues with this study, would the results still be applicable to your practice?

• This study was completed with Americans, living in Illinois and Minnesota. Do you think that thiswould limit the applicability of the results to Canadians?

You can join the on-line discussion for this CAP at www.caot.ca beginning January 15, 2007 and ending February 30, 2007.

In the early 1970's there were three occupational ther-apists on Prince Edward Island (P.E.I.), but this numberhas now grown to 37 therapists practicing on theisland. In 1973, these three therapists were invited byKate Coffman to the first OT Atlantic held in NewBrunswick. In 1974, the three P.E.I. occupational thera-pists, a physiotherapist, family and friends hosted thesecond OT Atlantic conference. It was a terrific oppor-tunity for occupational therapists to gather and net-work, with island therapists billeting their colleagues.

From a modest beginning with social eventshosted in homes and some client assistance to prepare the seafood chowder, OT Atlantic has evolvedinto a full-fledged conference. This past September2006 we had nearly 100 people attend! Held at awaterfront resort and conference centre, the 2 daypre-conference workshops, corporate sponsors andaccommodations were well received. The HonourablePat Binns, Premier of P.E.I., provided the delegates and sponsors with an opportunity to celebrate P.E.I.'sfascinating occupational therapy history. Listeningwith pride, they heard this excerpt from the speech:

“Good morning, co-chairs Yvonne Thompsonand Heather Gauthier, Olympian Heather Moyse,occupational therapists, ladies and gentlemen.Thank you for inviting me to join you this morning.Although this is officially day one of the conference,I know you had a very interesting presentation last

evening with Dr. Mary AnnMcColl during the sixth annualKelly Bang Memorial Lecture. Iunderstand Dr. McColl's timelysubject dealt with the future ofoccupational therapy in pri-mary care. What a perfect kickoff to a conference entitled Seasof Change.

Keeping on top of changesin attitudes, changes in patientcare and changes in therapies isprobably one of the mostimportant responsibilities foran occupational therapist, and

makes Seas of Change a most appropriate name for this2006 OT Atlantic Conference. The profession of occupa-tional therapy is probably one of the most rapidlychanging fields of work these days, so it is interesting

to note that the role of an occupational therapist inhealth care got off to a rather slow start with one occu-pational therapist working at (what were then knownas) Riverside Hospital and the Provincial Sanatorium inthe mid 50s and the introduction of a new occupationaltherapy department in the Rehabilitation Centre in theearly 60s.

I believe it wasn't until the 70s that P.E.I. increasedthe number of occupational therapists to more thanone, and finally, in the mid 70s the Registered Occu-pational Therapists Act was tabled on the floor of theLegislative Assembly. With the exception of minor revisions, that act remained in place until 10 years ago,when the new legislation, The Occupational Therapists'Act was proclaimed. Your continued enthusiasm foraccepting and adapting to changing times and trendsspeaks volumes about your commitment to excellence.

Occupational therapists are valued members ofour health care teams. Through therapy, people areoften able to participate more fully in day-to-day livingand working. Patients learn how to manage pain,prevent injury, cope with everyday activities in spite of personal challenges, reduce hospital stays or early nurs-ing home admissions, continue to work and continue toserve as productive members of their community.

Opportunities such as this Atlantic conferenceoffer an excellent opportunity for you to remain in tunewith current practice trends, research, and successes.Your dedication to your profession, and to the clients youserve is evident through your willingness to continuallyadapt to changing times, demonstrated through yourinvolvement in this conference. I want to take a momentto commend the P.E.I. Occupational Therapy Society forhosting this conference and for providing this opportu-nity for occupational therapists to network with eachother while gaining valuable knowledge. I think I canspeak for islanders everywhere when I say we appreciateyou for all you do and for your commitment to helpingothers live life more fully.Thank you for offering me thisopportunity to address you and best wishes for a suc-cessful conference.”

So why share the phenomenon of OT Atlantic?What causes occupational therapists to give of theirprecious time? It is the inherent value of sharing howwe think and what we do. This continues to be ourmotivation along with passion, courtesy, collaboration,fun and good food!

OT Atlantic Conference 2006Seas of Change: A phenomenon

Jude Driscoll


About the author –Jude Driscoll is anoccupational therapistpracticing in PEI since1977. Since 1991, shehas worked withrecovering workers,employers, physiother-apists, physicians andchiropractors underthe umbrella of theWCB of PEI. Jude canbe reached [email protected]

Presentation to the Senate Standing Committeeon Social Affairs, Science and TechnologyIn November 2006, Dr. Mary Law represented CAOT at a meeting of the Senate Standing Committee onSocial Affairs, Science and Technology to discuss theoccupational therapy role for individuals with AutismSpectrum Disorder (ASD). CAOT recommended the federal government take a leadership role to develop anational strategy for children with disabilities, includinga national vision and action plan for ASD. The followingareas were proposed for review in an ASD action plan:

• System issues such as access and funding.• Integrated health human resource planning.• Wait list management strategy.• Research to develop evidence for ASD evaluation

and intervention.• Coordination and integration of ASD services

provided by health, education and social sectors.• Interventions and supports for families.• Education for consumers, health professionals

and government to ensure a comprehensiveapproach to ASD services.

Canadian Falls Prevention CurriculumThe Canadian Falls Prevention Curriculum is a three-year project to develop and pilot test a training curriculum for people working with older adults inthe area of falls prevention. Funded by the PopulationHealth Fund of the Public Health Agency of Canada inOctober 2005, the project will provide participantswith the knowledge and skills needed for an evidence-based approach to seniors falls prevention. The projectteam is developing the curriculum to be reviewed bythe advisory committee and pilot tested in Vancouverin early 2007. Assistance from CAOT will be to reviewcurriculum content, recruit participants for pilot test-ing and help to disseminate project deliverables.

Development of an InterprofessionalFramework for Case Management inOccupational Therapy, Physiotherapy andSpeech Language PathologyCAOT continues to respond to members' needs todevelop a method to measure caseloads; an essential

measure for human resource planning and deliveryof quality services. CAOT has partnered with physio-therapy and speech-language pathology associationsto address this issue as all three disciplines share theneed to develop a framework to measure caseloads.In September 2006, CAOT submitted a projectproposal: The Development of an InterprofessionalFramework for Case Management in OccupationalTherapy, Physiotherapy and Speech LanguagePathology. The proposal is aligned with the govern-ment’s priorities to review wait time managementand the health human resources pan-Canadianframework.

National Human Resources Database ProjectThis project is coordinated by the Canadian Instituteof Health Information (CIHI) to develop a supply-based database of information for five health profes-sions: occupational therapy, pharmacy, physiotherapy,medical laboratory technicians and medical radiationtechnicians.

In the late spring of 2006, CAOT become a dataprovider for the national occupational therapist data-base for members working in the three territories.Extensive work was undertaken to reconfigure theCAOT membership application and renewal form tocollect data using the data elements defined by thisproject. In October 2006, CAOT reported the first datato CIHI and the other data providers. The initial reportregarding the collected data is expected to be pub-lished by CIHI in the fall of 2007.

Enhancing Interdisciplinary Collaboration inPrimary Health Care (EICP) Initiativewww.eicp.caThe objective of the EICP initiative, funded by HealthCanada’s Primary Health Care Transition Fund, was toencourage health professionals to work together toproduce the best health outcomes for clients andproviders. Concluding in September 2006, the two-year interdisciplinary initiative produced an extensivetool kit available at www.eicp.ca. The tool kit assistspeople to develop a primary health care practice andis comprised of case studies and strategies.


Canadian Association of OccupationalTherapists: On your behalf

Population-needs Based Planning Tool forOccupational Therapy in Primary CareIn September 2006, CAOT began working with Dr. Mary Ann McColl from Queen’s University to developa validated tool to integrate occupational therapy intothe primary health care system. The project will be completed by August 2007 and is supported by aninterprofessional advisory group appointed by CAOT.

Primary Health Care Awareness CampaignThe CAOT Primary Health Care Awareness Campaigncontinues in the second year with 19 volunteers participating throughout Canada. The campaign isguided by a national advisory group of CAOT stake-holders. Training sessions are available to volunteersand members of the advisory group. The campaignwill continue this year to provide further opportunityfor information uptake on primary health care.

Workforce Integration ProjectFunded by the Government of Canada ForeignCredential Recognition Program, the project was led by CAOT. The project began in May 2005 and concluded in November 2006. Project objectives were to identify issues that enable/inhibit workforceintegration of international graduates and developrecommendations for future action.

An advisory committee provided input into themethodology of the Workforce Integration Project,assisted with gaining access to information requiredto meet project objectives and identified recommen-dations based on the findings of the study. The membership of the advisory committee included representatives from stakeholder groups havinginterest in the workforce integration of internationaloccupational therapy graduates. The project gainedan understanding of workforce integration issues forinternational occupational therapy graduates frommany perspectives. The full report of the project willbe posted in English and French on the CAOT website. The recommendations of the project can befound on page 16 of this issue of OT Now.

Canadian Alliance on Mental Illness andMental Health (CAMIMH)www.camimh.caThe primary goal of CAMIMH is to support the devel-opment of a national action plan for mental illnessand mental health for Canada. CAMIMH publishedthe Framework for Action on Mental Illness and

Mental Health and the publication was sent to allHouse of Commons and Senate members, as well assenior government officials.

CAMIMH organized Mental Illness AwarenessWeek (MIAW), held from October 1 to 7, 2006. DianeMéthot and Myriam Faye represented CAOT at theChampions of Mental Health Luncheon on October 4,2006. CAOT supported MIAW by distributing approxi-mately 5,100 MIAW posters and bookmarks to CAOTmembers, informing occupational therapists aboutMIAW through an e-mail blast and encouraging CAOTmembers to post their events on the MIAW web site.

The Mental Health Literacy Project was thefocus of the CAMIMH members meeting held onOctober 4, 2006. CAMIMH recently commissioned aseries of focus groups to obtain an understanding ofmental health literacy. The project results will providevaluable information to the Canadian Mental HealthCommission.

Chronic Disease Prevention Alliance ofCanada (CDPAC) www.cdpac.caThe CDPAC is a coalition of provincial, territorial andnational organizations, researchers, practitioners andpolicy makers. The vision of CDPAC is for an integrat-ed system of chronic disease prevention in the threeleading chronic diseases in Canada: cancer, cardiovas-cular disease and diabetes. The role of CDPAC roleincludes the following:

• Advocate for integrated research, surveillance,policies and programs, as well as the resourcesto positively influence the determinants ofhealth.

• Promote chronic disease prevention efforts thatreduce exposure to tobacco smoke, increasephysical activity and reduce unhealthy nutritionpractices.

• Support learning by facilitating information-sharing and dialogue among researchers, practi-tioners, policy planners and others who canimprove understanding of the required healthand social system changes.CAOT members can subscribe to CDPAC

Newsbytes, a free electronic newsletter for individualsinterested in chronic disease prevention available at:www.cdpac.ca/content/newsroom/newsbytes.asp.


Canadian Working Group on HIV andRehabilitation (CWGHR)www.hivandrehab.caThis past August, CWGHR was involved in theInternational AIDS Conference held in Toronto.CWGHR hosted four education sessions and a posterpresentation on the Interprofessional Learning inRehabilitation in the Context of HIV Project. CWGHRis also working on a project to address the systemicbarriers to labour force participation for people livingwith episodic disabilities. Debra Cameron from theUniversity of Toronto represents CAOT on the advisorycommittee for CWGHR. You can read more about thevarious CWGR activities in this issue of OT Now onpage 3 or on the CWGR web page.

National Board for Certification inOccupational Therapy (NBCOT)www.nbcaot.orgThe NBCOT is a not-for-profit credentialing agencythat provides certification for the occupational therapyprofession in the United States. All occupational therapists who wish to practice in the U.S. must passthe NBCOT certification exam. CAOT has been communicating with NBCOT due to their recentannouncement that effective January 1, 2007 onlyoccupational therapists with Master’s degrees will beeligible to write the NBCOT certification exam. Thishas been a concern to many of CAOT members andstudent members. NBCOT has issued a revised state-ment that will permit a foreign candidate to writethe NBCOT exam provided they can show evidence ofequivalency to the U.S. Master's requirements andthey are graduates of NBCOT approved programs.

National Network of Libraries for Health (NNLH)NNLH is a coalition of organizations interested in thedevelopment of a system that will ensure that allhealth care providers in Canada have equal access tothe best information for client care. The system willbe designed to fit the Canadian health care modeland fill in information gaps inherent in a complexhealth delivery system. NNLH is sponsored by theCanadian Health Libraries Association (CHLA).

In June 2005, a CAOT representative attended aNNLH stakeholders meeting. At this meeting a highlevel of support was received from the meeting participants, including representatives from healthprofessional associations, the Public Health Agencyand the Canadian Institute for Scientific and

Technical Information. CAOT has provided input intothe consultation for a national health informationsystem. The feedback received was used by CHLA todevelop a detailed business plan with costs and timelines. A copy of the concept paper is available at http://chla-absc.ca/nnlh/indexe.htm.

Pan-Canadian HHR Planning FrameworkConsultation WorkshopIn October 2006, CAOT and the members of theHealth Action Lobby (HEAL) were invited to attend thePan-Canadian HHR Planning Framework ConsultationWorkshop by the Federal/Provincial/TerritorialAdvisory Committee on Health Delivery and HumanResources (ACHDHR). The 2003 First Minister’s Accordon Health Care Renewal identified that:

Appropriate planning and management ofhealth human resources (HHR) is key to ensur-ing that Canadians have access to the healthproviders they need, now and in the future.Collaborative strategies are to be undertaken to strengthen the evidence base for nationalplanning, promote inter-disciplinary providereducation, improve recruitment and retention,and ensure the supply of needed healthproviders.In response to this directive the ACHDHR has

developed an action plan designed to support collab-orative pan-Canadian HHR planning. The plan sets outthe principles for collaboration and identifies keyactions that jurisdictions can take together to overcomebarriers to implement system-design/populationneeds-based planning, avoid the risks and duplicationassociated with the current jurisdiction-by-jurisdictionplanning approach and increase their HHR planningcapacity. The goals of the workshop were the following:

• To inform stakeholders of the results of the consultation on the Framework for Collaborative Pan-Canadian Health Human Resources Planning.

• To inform stakeholders of the RevisedFramework’s Action Plan and current pan-Canadian HHR planning activities.

• To engage stakeholders in the implementationof the Framework’s Action Plan.The outcomes of the workshop will be released in

the next few months with recommendation for collabo-rative strategies to advance a pan-Canadian framework.


2007 COTF Awards ProgramResearch Grants – Deadline February 28COTF Research Grant $20,000 (4 x $5,000)Critical Literature Review $10,000 (2 x $5,000)GrantJ.V. Cook & Associates $1,500Qualitative Research Grant

Scholarships – Deadline September 30CIHR $11,000SickKids $10,000 (2 x September

@ $2,500 per scholar-ship & 2 x February @ $2,500 per scholarship)

Master’s $3,000 = 2 x $1,500 (2 x due to partnership with SickKids)

Doctoral $6,000 = 2 x $3,000 (2 x due to partnership with CIHR)

Thelma Cardwell $2,000Goldwin Howland $2,000Invacare $2,000

Other AwardsJanice Hines Memorial $1,000Award (September 30 deadline)Marita Dyrbye Mental $1,000 ($1,000 every 2 years)Health Award (March 31 deadline)

Please refer to the COTF web site for details of the2007 awards program. For application forms, see theopportunities for researchers section at www.cotf-canada.org.

Updates on the COTF boardOn September 30, 2006 the terms ended for threeCOTF governors. Debra Cameron began on the COTFboard as a governor in 1998 and was the presidentfrom 2000 to 2003. She continued as a governor

until 2006. Debra was a very dedicated and hardworking member of the COTF board whose passionand enthusiasm were contagious. She will be greatlymissed. Sandra Bressler joined the board in 2002 andwas the president from 2003 to 2006. She wasinstrumental in successfully moving COTF from itsformer Toronto location to Ottawa with the CAOTnational office. Sandra’s understanding of CAOT andCOTF tremendously benefited both organizations dueto their close working relationship. Diane Méthot, asCAOT president, was on the COTF board from 2004 to2006. Her support of COTF and her participation atthe COTF board was valued. Thank you to all threegovernors for their time and effort!

COTF welcomes new governors Sue Forwell, the present CAOT president, joins theboard. Rachel Stack has returned to the COTF board.Rachel is a fieldwork coordinator / lecturer in theDepartment of Occupational Science andOccupational Therapy at the University of Toronto.Huguette Picard from the Université de Montréal alsojoined the board in April 2006. COTF welcomes allthree governors to the board.

2006 Donor reception and art abilityCOTF held its donor reception on October 18, 2006 atthe Steam Whistle Brewing in Toronto. The donorreception welcomed current, past and potentialdonors. The reception provided a forum for network-ing and for COTF to thank its donors and guests fortheir support. Following the donor reception, guestshad the opportunity to attend Art Ability. Thisfundraising event showcased the work of local artists.This enjoyable event was successful for COTF. Thankyou to those who attended both of these events andsupported COTF!

Remember to update your COTF contactinformationCOTF would greatly appreciate it if you would informSandra Wittenberg of changes to your COTF contactinformation. Sandra can be reached at [email protected] or 1-800-434-2268


Update from the COTF

Margaret ArmbrusterSue BaptisteJeff BonifaceJane BowmanSandra Bressler�

Amy CaldwellDeb CameronDonna CampbellCanadian Association ofOccupational TherapistsMargo CarknerAnne CarswellChristina Ching Yee FungMary Clark �

Sandy DaughenJohanne Desrosiers�

Patricia Erlendson�

Marcia Finlayson

Sharon Friefeld (in kind)Margaret FriesenFuture Mobility �

Karen GoldenbergIris Greenspoon�

Healthcare Inc. (in kind)Susan Harvey�

Sangita KambléDonna Klaiman�

Pat LeeceLori Letts�

Mary ManojlovichKatherine McKayGuylaine MercierDiane MéthotJan Miller PolgarCheryl Missiuna


Your support counts!COTF sincerely thanks the following individuals, companies and organizations for their generous supportduring the period of August 1 to September 30, 2006. For those whose names do not appear in this listing,please see the next issue of OT Now.

Linda Petty (in kind)�

Gayle RestallJacquie RipatAnnette RivardPatricia Rodgers�

Debra StewartAnne StricklandThelma SumsionFern Swedlove�

Beverlea Tallant (in kind)Barry Trentham�

Irvine WeekesMuriel WestmorlandSeanne Wilkins�

Karen Yip�

4 anonymous donors

CONFERENCES

Progressive Goal AttainmentProgram (PGAP) TrainingWorkshop: A new program for minimizing pain-related disabilityJanuary 26 & 27, 2007 in Ottawa,Ontario and February 2 & 3, 2007 in Montreal, Quebec (the Montrealworkshop is in French) and March 2& 3, 2007 in Halifax, Nova Scotia.Provider: Dr. Michael JL Sullivan -University Centre for Research onPain and DisabilityContact: Heather AdamsTel: (902) 471-7864 Fax: (902) 421-1292E-mail: [email protected] : www.pdp-pgap.com

Health Leaders InstituteMarch 30-31, 2007Bank of Montreal Institute forLearning, Toronto, ONContact: Judith Skelton-GreenTel: (705) 549-7749 Fax: (705) 549-8906E-mail: [email protected]

ApraxiaJanuary 20-21, 2007Eye Care Centre Auditorium10th / Willow St., Vancouver, BCContact: Dianna Mah-Jones Tel: (604)263-8730 Fax: (604)263-8730E-mail:[email protected]

CANADIAN HEALTHCARE ASSOCIATIONRisk Management and Safety in Health ServicesCourse starts every September.Continuous Quality Improvement for Health ServicesCourse starts every September.Modern Management Correspondence courseSeptember 2006 - April 2007 Contact: Cheryl Teeter, DirectorCHA Learning, 17 York Street,Ottawa, ON, K1N 9J6Tel: (613) 241-8005, ext. 228 Fax: (613) 241-5055E-mail: [email protected]

WEB-BASED DISTANCE EDUCATION

Post Professional GraduatePrograms in RehabilitationSciences University of British Columbiaand McMaster UniversityCourses offered twice a year inSeptember to December & Januaryto April. Courses: EvaluatingSources of Evidence, Reasoning,Measure-ment, DevelopingEffective Programs, Facilitating

Learning in Rehab Contexts.Graduate Certificate is grantedafter completion of 5 courses. Thesecourses can be applied to Master'sprograms at each university, if thecandidate is eligible.Contact: [email protected] Tel: 604-822-7050Websites: http://www.mrsc.ubc.caor www.fhs.mcmaster.ca/rehab/

Dalhousie University SeriesProgram Evaluation forOccupational Therapists (OCCU5043)Date: January - April 2007Instructor: Dr. Reg Urbanowski Advanced Research Theory andMethods for Occupational Therapists (OCCU5030)Dates: January - April 2007Instructor: TBAIdentity and Transitions (OCCU5040)Dates: May - June, 2007Instructors: TBAContact: Pauline Fitzgerald School of Occupational Therapy,Dalhousie University, 5869University Avenue, Forrest Bldg,Room 215, Halifax, NS, B3H 3J5.Tel: (902) 494-6351E-mail: [email protected]

CAOT endorsed courses


For more information about CAOT endorsement, e-mail [email protected] or Tel. (800) 434-2268, ext. 231

“Education is simply the soul of a society as it passes from one generation to another.”B.K. Chesterton in the Observer, ‘Sayings of the Week’, July 6, 1924

Documents

OCCUPATIONAL THERAPY NOW2 occupational therapy now volume 9.1 Statements made in contributions to Occupational Therapy Now are made solely on the responsibility of the author and unless