Papers by Dorothy Kessler
The majority of people living with the effects of stroke experience participation challenges. Occ... more The majority of people living with the effects of stroke experience participation challenges. Occupational Performance Coaching for stroke survivors (OPC-Stroke) is designed to promote engagement in personally identified participation goals and develop the ability to address future participation goals. Purpose: This thesis explored the potential efficacy of OPC-Stroke, its mechanisms of action, and the feasibility and acceptability of the randomized controlled trial methods to inform the planning of a larger trial. A pilot randomized controlled trial with an embedded qualitative component. Twenty-one participants were randomly assigned to receive 10 sessions of OPC-Stroke or usual care. Participation, goal performance and satisfaction, goal self-efficacy, emotional well-being, and cognition were measured at pretest, posttest and six months follow-up. Qualitative interviews were conducted at posttest with individuals who were in the intervention group. No significant between group differences were noted for any outcomes, although scores for cognition approached significance (p=0.065) and also showed a large effect size (partial eta squared =0.167). Examination of effect sizes indicated a moderate clinically significant benefit of OPC-Stroke for goal performance and satisfaction scores (partial eta squared = 0.075 and 0.078 respectively). Participation scores improved for both groups but the overall trajectory of participation seemed to be different between groups. Goal self-efficacy remained stable across time and groups, and emotional well-being declined in both groups. Qualitative findings confirmed that all components -emotional support, individualized education and goal-focused problem-solving -made important contributions to promote achievement of x
British Journal of Occupational Therapy, Mar 13, 2018
Australian Occupational Therapy Journal, Jan 30, 2015
Background/aim: Coaching has been identified as a core enablement skill of occupational therapist... more Background/aim: Coaching has been identified as a core enablement skill of occupational therapists. Occupational therapists have begun to embrace the use of coaching as a therapeutic tool to promote client-centeredness in their practice. As the use of coaching becomes more popular it is important to examine and evaluate coaching use in occupational therapy practice to clarify what is meant by coaching and inform future research and practice in this area. Methods: An integrative literature review was conducted to examine how coaching is being used by occupational therapists, identify the similarities and differences between coaching interventions and to identify the empirical evidence for the use of coaching in occupational therapy. Results: The literature search resulted in 24 articles describing 11 different interventions that reported use of coaching methods by occupational therapists with various populations. Similarities among interventions included goal setting, problem solving and an educational component. Differences in the directiveness of the occupational therapist were evident. The level of research evidence for individual interventions ranges from low to moderate. Conclusions: Differences are evident in the coaching theories and methods used in occupational therapy. While evidence of effectiveness of these interventions is promising, study designs used to date are vulnerable to bias and have had small sample sizes, limiting the strength of evidence. More research using clear descriptions of the coaching approach and more robust research methods is needed to better inform clinical practice.
Disability and Rehabilitation, Jan 27, 2022
PURPOSE Peer-based interventions are increasingly popular and cost-effective therapeutic opportun... more PURPOSE Peer-based interventions are increasingly popular and cost-effective therapeutic opportunities to support others experiencing similar life circumstances. However, little is known about the similarities and differences among peer-based interventions and their outcomes for people with neurological conditions. This scoping review aims to describe and compare the characteristics of existing peer-based interventions for adults with common neurological conditions. MATERIALS AND METHODS We searched MEDLINE, CINAHL, PsychInfo, and Embase for research on peer-based interventions for individuals with brain injury, Parkinson's, multiple sclerosis, spinal cord injury, and stroke up to June 2019. The search was updated in March 2021. Fifty-three of 2472 articles found were included. RESULTS Characteristics of peer-based intervention for this population vary significantly. They include individual and group-based formats delivered in-person, by telephone, or online. Content varied from structured education to tailored approaches. Participant outcomes included improved health, confidence, and self-management skills; however, these varied based on the intervention model. CONCLUSION Various peer-based interventions exist, each with its own definition of what it means to be a peer. Research using rigorous methodology is needed to determine the most effective interventions. Clear definitions of each program component are needed to better understand the outcomes and mechanism of action within each intervention.IMPLICATIONS FOR REHABILITATIONRehabilitation services can draw on various peer support interventions to add experiential knowledge and support based on shared experience to enhance outcomes.Fulfilling the role of peer mentor may be beneficial and could be encouraged as part of the rehabilitation process for people with SCI, TBI, Stroke, PD, or MS.In planning peer-based interventions for TBI, Stroke, SCI, PD, and MS populations, it is important to clearly define intervention components and evaluate outcomes to measure the impact of the intervention.
Canadian Journal of Occupational Therapy, Aug 7, 2014
The Open Journal of Occupational Therapy, Apr 1, 2016
Background: Background:Stroke is a leading cause of disability in adults. Following stroke, 60% o... more Background: Background:Stroke is a leading cause of disability in adults. Following stroke, 60% of people report needing help with everyday activities, and 80% report having very few meaningful activities. These restrictions often continue for years. This study explored the efficacy of Occupational Performance Coaching for stroke survivors (OPC-Stroke) on the participation level of adults in the later stage of stroke rehabilitation. Method: Method: A descriptive case study design was used. One participant in the later stages of rehabilitation was recruited. Outcome measures for participation, goal performance and satisfaction, and emotional well-being were administered pre and postintervention to observe for direction of change. A semistructured interview was carried out postintervention to explore the participant's experiences of the intervention. Results: Results: The participant who took part in the study reported improvement with his goal performance and satisfaction. However, the level of participation did not improve and emotional well-being decreased. Qualitative data revealed an appreciation of the intervention and a recommendation of the intervention for others. Conclusion: Conclusion: OPC-Stroke was valued by the participant and shows promise for improving goal performance and satisfaction. Further research is necessary to determine the potential efficacy of OPC-Stroke in later stages of rehabilitation.
Pilot and Feasibility Studies, Sep 3, 2021
Background: The worldwide prevalence of anxiety in older adults is estimated at between 6 and 10%... more Background: The worldwide prevalence of anxiety in older adults is estimated at between 6 and 10%. In Canada, adults 65 and older experience anxiety at a rate of 6.4%, affecting more than 300,000 people. Anxiety in older adults has been linked to difficulties retaining new information and engaging in instrumental daily activities of living. Due to COVID-19 restrictions, novel methods of delivering therapy programs remotely are needed; however, data is limited. There is some evidence that older adults prefer non-pharmacological approaches for anxiety that can be delivered in the community. Emotion-focused mindfulness therapy (EFMT) is a mindfulness-based intervention that emphasizes meditation and observing thoughts and emotions as they arise. This emphasis has been demonstrated to reduce symptoms of anxiety in general populations. This study aims to evaluate the feasibility of EFMT with older adults. Methods: This pilot feasibility randomized controlled trial will use a wait list control trial design. Due to COVID-19 restrictions, we will use telehealth delivery via Zoom rather than in-person delivery. The first 48 people to meet the eligibility criteria will be randomly allocated to either receive EFMT immediately, or in approximately 8 weeks time from enrollment (1:1 allocation ratio). Data will be collected at baseline, 8 weeks following baseline, and 16 weeks following baseline. The primary outcomes will determine the feasibility of the intervention based on recruitment, enrolment, retention, and adherence to all components of the intervention. The secondary outcome will be changes to anxiety over time. Discussion: The results of this trial will determine the feasibility and potential effectiveness of video-delivered EFMT for late-life anxiety compared to no treatment. If the results are promising, a larger randomized controlled trial may be conducted. Trial registration: ClinicalTrials.gov, NCT04415528. Registered on
British Journal of Occupational Therapy, Sep 1, 2012
Background: Stroke is one of the most common disabling conditions of adulthood. Participation pro... more Background: Stroke is one of the most common disabling conditions of adulthood. Participation problems are extremely common post-stroke. Occupational therapists, by virtue of their commitment to enabling occupation, are in a strong position to help stroke survivors improve their participation. To demonstrate effectiveness, occupational therapists must be able to provide evidence of post-treatment changes in participation. Objective: The objective of this paper was to identify participation measures that have been developed for, or tested with, individuals who have experienced a stroke and to review them for use as occupational therapy outcome measures. Method: A literature review was carried out to locate relevant tools. These tools were then rated for psychometric and clinical properties that are critical for clinical outcome measurement. In addition, the theoretical fit of each evaluation with occupational therapy's commitment to client-centredness was considered. Results: Ten evaluations were identified and rated. These ratings were designed to assist occupational therapists to choose a participation measure for their practice. Conclusion: Selection and use of such a measure will help occupational therapists to document its effectiveness in improving participation among stroke survivors.
Patient Education and Counseling
British Journal of Occupational Therapy
Introduction: University students are at a high risk for mental health difficulties. Occupational... more Introduction: University students are at a high risk for mental health difficulties. Occupational performance coaching is an action-oriented and strengths-based approach that can help clients set and accomplish personally valued goals. We carried out a pilot project to evaluate a tele-rehabilitation occupational performance coaching service for university students within an occupational therapy fieldwork placement. Method: A pretest post-test design was used. Severity of symptoms of depression, anxiety and stress and goal achievement were measured before and after the intervention and semi-structured interviews were carried out with student clients and student therapists. Development of student therapist competencies were noted. Results: Thirty-five student clients enrolled in occupational performance coaching and participated in 1–6 sessions. They identified academic, health, social and vocational goals. Through occupational performance coaching, clients made important progress on ...
Canadian Journal of Occupational Therapy
Background: Patients with heart failure (HF) usually experience functional disabilities and face ... more Background: Patients with heart failure (HF) usually experience functional disabilities and face participation challenges. Self-care behavior is an essential component of long-term management of HF. Purpose: This study aims to investigate the effect of occupational performance coaching (OPC) on self-care behaviors and participation in people with HF. Method: This study is a parallel group, single-blind, randomized controlled trial of 44 adults with HF, to evaluate the efficacy of OPC. Patients will be randomly allocated (1:1) into two groups. Both groups will receive usual self-care education and the intervention group will receive eight weekly sessions of OPC as well. We will measure the primary and secondary outcomes at baseline, 8, and 12 weeks after the intervention initiation. Implications: If OPC is superior to usual self-care education on improving self-care behavior and participation, the finding will support the integration of OPC into practice to improve participation and ...
Journal of Gerontology and Geriatrics
Aging & Mental Health
Clinical Rehabilitation
Objective To determine the feasibility of adding coaching sessions to a website (MS INFoRM) that ... more Objective To determine the feasibility of adding coaching sessions to a website (MS INFoRM) that supports self-directed fatigue management for people with multiple sclerosis (PwMS). Design Double-blind, parallel-group feasibility study. Participants and setting Twenty-six PwMS, who experienced severe fatigue (fatigue severity scale > 5.4), were recruited from participants who were ineligible for the main trial testing on the MS INFoRM website. Intervention Six 45-to-60-min sessions of one-on-one coaching plus access to the MS INFoRm website compared to two check-in phone calls plus access to the MS INFoRm website. Both study arms took place over 3 months. Main measures Feasibility parameters included proportion eligible of those screened; proportion consented; missing data; retention and adherence rates. Acceptability was explored through qualitative interviews. Secondary outcomes (self-efficacy and fatigue impact) were measured at baseline and post-intervention. Results 76 peopl...
International Journal of Therapy and Rehabilitation, 2020
Background/aimsOccupational performance coaching is a family-centred approach that helps mothers ... more Background/aimsOccupational performance coaching is a family-centred approach that helps mothers who have children with occupational performance challenges. This study sought to identify the barriers and facilitators to goal achievement and engagement with occupational performance coaching based on the experiences of mothers of children with cerebral palsy who were receiving occupational performance coaching.MethodsThis qualitative study was embedded within a randomised control trial. Twelve mothers of children with cerebral palsy who had received occupational performance coaching were interviewed using a semi-structured interview technique. Their responses were analysed using inductive content analysis.ResultsThe most important barriers to goal achievement and engagement with coaching were societal, family-related and mother-related factors. The facilitators were new resources, family cohesion, mother-related factors and child-related factors.ConclusionsDifferent factors can affect...
Pilot and Feasibility Studies, 2021
Background The worldwide prevalence of anxiety in older adults is estimated at between 6 and 10%.... more Background The worldwide prevalence of anxiety in older adults is estimated at between 6 and 10%. In Canada, adults 65 and older experience anxiety at a rate of 6.4%, affecting more than 300,000 people. Anxiety in older adults has been linked to difficulties retaining new information and engaging in instrumental daily activities of living. Due to COVID-19 restrictions, novel methods of delivering therapy programs remotely are needed; however, data is limited. There is some evidence that older adults prefer non-pharmacological approaches for anxiety that can be delivered in the community. Emotion-focused mindfulness therapy (EFMT) is a mindfulness-based intervention that emphasizes meditation and observing thoughts and emotions as they arise. This emphasis has been demonstrated to reduce symptoms of anxiety in general populations. This study aims to evaluate the feasibility of EFMT with older adults. Methods This pilot feasibility randomized controlled trial will use a wait list cont...
Physical & Occupational Therapy In Geriatrics, 2019
Aims: Occupational performance coaching (OPC) helps people reengage in personally valued occupati... more Aims: Occupational performance coaching (OPC) helps people reengage in personally valued occupations despite physical or cognitive challenges. We explored the potential of OPC in the context of assisted living. Methods: An instrumental case study was used. A student occupational therapist provided OPC to one resident in one assisted living facility. Interviews with the resident, a family member, and the Health and Wellness Director, and the student's journal notes were analyzed to explore the experience of OPC and determine critical considerations for OPC in this environment. Results: Positive effects were noted for the resident and the residence. Critical considerations for OPC in this environment included an increased facilitation role for the coach, and the importance of an appreciation of potential stress for family and contributions by residence staff. Conclusions: OPC is feasible and potentially effective in assisted living with greater consideration of family needs and staff involvement.
Disability and rehabilitation, Jun 13, 2016
Conceptualizations of risk in seniors' rehabilitation emphasize potential physical injury, fu... more Conceptualizations of risk in seniors' rehabilitation emphasize potential physical injury, functional independence and cost containment, shifting rehabilitation from other considerations essential to promoting a satisfying life. In a two-day multidisciplinary planning meeting we critically examined and discussed alternatives to dominant conceptualizations. Invitees reflected on conceptualizations of risk in stroke rehabilitation and low vision rehabilitation, identified and explored positive and negative implications and generated alternative perspectives to support rehabilitation approaches related to living a good life. Current risk conceptualizations help focus rehabilitation teamwork and make this work publically recognizable and valued. However, they also lead to practice that is depersonalized, decontextualized and restrictive. Further research and practice development initiatives should include the voices of clinicians and seniors to more adequately support meaningfully l...
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Papers by Dorothy Kessler