The Occupational Therapy Section has completed a study of occupational therapy process in routine treatment sessions. The purpose of the study was to devise a way to examine process and outcome links in a treatment session. Future plans are to link session outcomes to the overall effect of a treatment program. Twenty patients (10M, 10F) with a variety of diagnoses (mental illness 35 percent, neurological 25 percent, cancer 20 percent, musculoskeletal 10 percent, and spinal cord injury 10 percent) have participated in the study. Examination of 60 interviews of patients at NIH and National Rehabilitation Hospital (NRH) revealed four occupational therapy process variables: occupational form, occupational performance, goals, and reflection. These process variables showed a clear distinction between description (of treatment goals, task, environment, and performance) and analysis, in the form of reflection, during review of experiential learning using typical therapeutic occupations. Descriptive statistics showed that reflection was most frequently cited by patient (48 percent) and therapist (37 to 40 percent) in each of three post-session interviews of patients by a treating therapist. Three types of reflection were revealed: content reflection (analysis of occupational form), process reflection (analysis of occupational performance), and premise reflection (analysis of self-management). Further, Spearman correlation coefficients found a significant negative correlation between patient performance and reflection for both patient and therapist in all three sessions. Description and analysis are related, but separate, process variables. Patterns of process in a treatment session are worthy of further examination. A continuation of this study will include 30 additional participants from NIH, NRH, and Walter Reed Army Medical Center (IRB review in process). This study will compare reflection using two interview formats to determine if the type of post-session interview influences the nature and proportion of reflection.
