Ranka, J., (2005, November). Arm in arm or up in arms? Invited key note address at the Occupational Therapy Australia – Queensland State Conference “OT in Arms”, Brisbane, Qld.

A primary aim of occupational therapy is to enhance performance and participation of people whose occupational performance has been compromised by physical, cognitive or psychosocial impairments or delays, as well as, environmental constraints. Many of the clients seen by occupational therapists have compromised occupational performance as a result of conditions and impairments that affect the arm and hand in different ways. Occupational therapists are expected to identify the occupational performance limitations that exist and, at least, be knowledgeable about the conditions and impairments that cause these limitations.

Contemporary occupational therapy practice is typically described as client-centred, collaborative and occupation-focused. Is this the reality? Many practice contexts demand quick decision-making and rapid service delivery. Therapists have little time to gain a view of life from the perspective of the client and his or her role partners. Therapists are expected to be directive and prescriptive rather than collaborative. Methods used in practice are often technique-focused and this is encouraged, somewhat, by the current evidence-based health care paradigm. How do we assert and demonstrate our unique role in the health care team? Employers and clients are entitled to data that demonstrates occupational therapy outcomes, yet measures of occupational therapy outcome are few and often do not fit the expectations of administrators. Policy-makers and employers continue to explore the concept of a multi-skilled workforce, and educators are being urged to develop generic professional preparation programs. How will we maintain our place in health care?

The purpose of this paper is to explore the challenges facing occupational therapy practice further and to present ideas for how to address them. Specifically, I will present a framework for client-centred, occupation-focused practice that encompasses the totality of practice regardless of the clients seen, the context of practice or the techniques used. Case examples of clients with a variety of arm and hand disorders will be used to illustrate key points. I will then demonstrate how this model can be used to assert our unique place in health care. A summary of the research evidence about occupation-focused practice in upper limb and hand therapy will be presented, and a client-centred method of collecting specific evidence about outcomes in occupational performance will be described. Finally, I will discuss my perspective on the research imperatives facing practice and make suggestion for how this research can be carried out.