Roles Following Stroke (OP Roles)
OCCUPATIONAL PERFORMANCE ROLES FOLLOWING STROKE
A thesis submitted in partial fulfilment of the requirements for the degree of Master of Applied Science (Research) Occupational Therapy. School of Occupation and Leisure Sciences, The University of Sydney
Anne Hillman M.App.Sc(OT), B.App.Sc. (OT)
Supervisor: Christine Chapparo PhD, MA, DipOT, OTR
Abstract
Research into rehabilitation outcomes demonstrates that people recovering from stroke experience serious role loss. Despite this, many occupational therapists working in stroke rehabilitation do not allocate time to therapy designed to achieve specific meaningful role resumption or role development. Occupational role performance has been neglected within the profession. In particular, little is known about the use of the concept by the role performer. Therapy is instead focused upon the restoration of function at the performance component level.
A naturalistic study was undertaken to provide descriptive information about the self-perceived occupational role performance of men over 65 following stroke, and to investigate the possibility that occupational role was a construct used by the participants to organise their occupational performance. Thirteen participants were interviewed in their own homes. Inductive analysis of the data produced the following findings.
There was evidence that participants did use role as a construct to organise role performance in terms of meaning, personal abilities and time. This organisation incorporated a large degree of choice about how roles were performed. Choices were made in relation to perceptions of environmental demands and informed by previous experience and personal standards for role performance.
A preliminary model of self-perceived occupational role performance was developed from the themes identified in the data. The constructs of the model represent the factors identified as contributing to the meaning, motivation, planning and performance of occupational roles by the participants in the study. Each major construct has a number of sub-constructs, and construct definitions were produced. The relationship between the constructs is complex.
The major constructs are named Active Engagement, Perceived Control and Personal Meaning. They relate respectively to doing, knowing and being as described in the Occupational Performance Model (Australia). Active Engagement describes the nature of occupational role performance and is principally related to doing. The construct of Personal Meaning strongly influences Active Engagement and is principally related to being. The last construct of Perceived Control relates to the reasoning of the participant about his role performance, and is principally related to knowing. Perceived Control informs Personal Meaning in terms of the perceived outcomes of Active Engagement.
The major outcome of this study has been the detailed identification and description of a number of constructs that relate to both the internal and external aspects of self-perceived occupational role performance for the study participants. These constructs extend the Occupational Performance Model (Australia) at the role level, and can form the basis of further research to develop a model of occupational role performance that would provide a valuable tool for research and for clinical practice.