Although spirituality is rarely explicitly mentioned in the occupational therapy literature, it is implied as an interwoven part of the human system. This article explores the meaning of occupation in the context of sociological and Judeo-Christian theological frameworks and the meaning of spirituality in the occupational therapy clinic. A case is made for acknowledging spirituality in clinical reasoning as a centralizing component of the patients' motivation and assignment of meaning to life.

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This paper explores the extent to which third-party reimbursement dictates occupational therapy practice. A literature review was used to examine the history and meaning of reimbursement in regard to occupational therapy. It was found that the profession has altered its definition, practice, management, ethics, and professional response as a result of changes in reimbursement. Reimbursement policies reflect societal influences and are shaping occupational therapy in several ways. Control has shifted to third-party payers, allowing them to define occupational therapy; use of the medical model is being rewarded by reimbursement; the language used to discuss the profession has changed to accommodate the insurance and other industries; and values that dominate society are being reinforced. Conflict between the values of society and the values of the occupational therapy profession is a source of struggle for many clinicians. If the causes of the reimbursement-imposed constraints on practice are understood, occupational therapists will be free to be proactive in issues of health care policy.

Minimal evidence exists regarding online education in occupational therapy. This study explored entry-level occupational therapy (OT) student responses to two methods of instruction in an applied OT theory course. The investigator used a retrospective quasi-experimental, nonrandomized comparison group design with mixed methods to compare two cohorts of entry-level OT students. Data included midterm exam, final exam, and cumulative course grades, as well as qualitative data from a final exam essay question. Demographic data and cohort mean grade-point averages were collected at the program level. One cohort received face-to-face instruction, while the other received online hybrid and face-to-face instruction. The face-to-face cohort had statistically significantly higher summative course grades. The investigator could not factor out pre-program GPA, which may have impacted results. With qualitative analysis, the investigator found evidence for a priori themes of the value of theory and growth in theory application. Emergent themes included use of theory for clinical reasoning, client-centered practice, theory integration in practice, and theory in the OT process. Students in the online hybrid section perceived that the course required more busywork. Online and hybrid instruction can be an effective means of content delivery for OT applied theory.

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