Independence: An Analysis of a Complex and Core Construct in Occupational Therapy

Introduction: Independence is a core concept in occupational therapy, but there is little consensus within the profession upon a universal definition. The present study employed a critical interpretive synthesis to examine two fundamental research questions: ‘How is independence conceptualised in quantitative and qualitative research within occupational therapy?’ and ‘How does the term “independence”, in its present use, critically impact occupational therapy policy and practice?’ Method: Articles pertaining to occupational therapy and contributing to the definition of independence within the profession were examined. Three successive levels of coding — open, axial and selective — were used to analyse 19 final articles. Findings: From the literature, nine definition themes emerged: function, autonomy and competence, control, context, culture, environment, personal attributes and safety. These themes were then organised into three categories: personal factors, environmental factors and continuum, which were synthesised together to create a model that addresses all factors critical to the composition of independence. In addition, four clinical themes developed: goal of occupational therapy, client-therapist relationship, variable definitions in occupational therapy practice and limitations of present practice. Conclusion: Through the formalisation of the integral components of independence, this study enables a standardised foundation for the examination of this core concept across the profession.