Susan Rappolt

University of Toronto, Toronto, Ontario, Canada

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Publications (34)72.24 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper, the first of two examining the concept of occupational justice, presents the findings of a scoping review of how occupational justice and its associated concepts (occupational deprivation, marginalization, alienation, imbalance or apartheid) have been conceptualized. Its purpose is to examine potential avenues and barriers for development and application of these concepts. The results indicate that perspectives on occupational justice emphasize individuals’ unique sets of occupational needs and capacities within particular environments. Based on the idea that participation in occupation can affect health, occupational justice is underpinned by a belief in the right to engage in diverse and meaningful occupations to meet people’s individual needs and develop their potential. In the literature, barriers to engagement in meaningful occupation are considered injustices. One impediment to enabling occupational justice in practice is the lack of conceptual clarity about occupational justice and its related terms. Before an occupationally just perspective can be further developed and utilised, the conceptual basis of occupational justice needs to be clarified and models for occupationally just practice need to be further developed.
    Journal of Occupational Science 03/2013; 21(4). DOI:10.1080/14427591.2013.775692
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    ABSTRACT: In this paper, we build on the findings from our scoping review (Durocher, Gibson & Rappolt, 2013) of occupational justice and its associated concepts, which revealed considerable conceptual confusion and barriers to the usability and understanding of occupational justice. In this paper we expand on those findings to provide a critique and way forward by drawing from four distinct perspectives. First, we take the stance of the sceptical occupational scientist to examine the interrelationships between occupation and health. We then consider occupational justice from a practice standpoint, and then from the view of the broad health care provider community. Finally, we discuss how the field of bioethics may contribute to occupational justice.
    Journal of Occupational Science 03/2013; DOI:10.1080/14427591.2013.775693
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    ABSTRACT: Purpose: To explore decision-making processes currently used in allocating occupational and physical therapy services in home care for complex long-stay clients in Ontario. Method: An exploratory study using key-informant interviews and client vignettes was conducted with home-care decision makers (case managers and directors) from four home-care regions in Ontario. The interview data were analyzed using the framework analysis method. Results: The decision-making process for allocating therapy services has four stages: intake, assessment, referral to service provider, and reassessment. There are variations in the management processes deployed at each stage. The major variation is in the process of determining the volume of therapy services across home-care regions, primarily as a result of financial constraints affecting the home-care programme. Government funding methods and methods of information sharing also significantly affect home-care therapy allocation. Conclusion: Financial constraints in home care are the primary contextual factor affecting allocation of therapy services across home-care regions. Given the inflation of health care costs, new models of funding and service delivery need to be developed to ensure that the right person receives the right care before deteriorating and requiring more costly long-term care.
    Physiotherapy Canada 03/2013; 65(2):125-132. DOI:10.3138/ptc.2012-09 · 0.61 Impact Factor
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    ABSTRACT: This paper introduces an inter-professional clinical practice guideline for vocational evaluation following traumatic brain injury. This guideline aims to explicate the processes and factors relevant to vocational evaluation to assist evaluators (i.e. health care teams, individuals and employers) in collaboratively determining if clients are able to work and to make recommendations for work entry, re-entry or vocational planning. Methods in the Canadian Medical Association's (CMA) Handbook on Clinical Practice Guideline and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were utilized to ensure rigour. Steps in the CMA handbook were followed and included: (1) identifying the guideline's objective and questions; (2) systematic literature review; (3) study selection and quality appraisal; (4) development of clear recommendations by key stakeholders; (5) guideline pilot testing and endorsement. The resulting guideline includes 17 key recommendations within the seven domains: (1) evaluation purpose and rationale; (2) initial intake process; (3) assessment of the personal domain; (4) assessment of the environment; (5) assessment of occupational/job requirements; (6) analysis and synthesis; (7) evaluation recommendations. The guideline may be useful to individually practicing clinicians, health care teams, employers and individuals with TBI. Future research will formally examine the success of the guideline's implementation.
    Journal of Occupational Rehabilitation 10/2011; 22(2):166-81. DOI:10.1007/s10926-011-9332-2 · 2.80 Impact Factor
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    ABSTRACT: This paper is a qualitative synthesis of clients' perspectives of the elements significant to return to work following traumatic brain injury (TBI). This is part of a larger review, completed to provide the evidence base for a vocational evaluation guideline. Processes outlined in the Cochrane Handbook of Systematic Review guided the full review including: developing review questions, search strategies and selection criteria; quality appraisal; data extraction, analysis and synthesis; drawing conclusions. Four data bases (i.e. Medline, Embase, PsychInfo, Cochrane) were searched for relevant qualitative studies. Evidence tables were used to extract data from studies and thematic analysis employed to analyze the qualitative data. Analysis of clients' perspectives on return to work resulted in four key themes including the following: 1) meaning of work; 2) process of return to work and reconciling new identities; 3) opportunities to try versus risks of failure; 4) significance of supports. Themes are discussed in relation to vocational evaluation and findings from other syntheses. Vocation evaluation should include the assessment of: the meaning clients ascribe to work following a TBI and their post-injury goals; clients' self-perceptions of work competency, work readiness and anticipated challenges with return to work; and the available supports.
    Disability and Rehabilitation 09/2011; 34(3):179-88. DOI:10.3109/09638288.2011.591881 · 1.84 Impact Factor
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    ABSTRACT: In order to develop the evidence base for a clinical practice guideline (CPG) for vocational evaluation following traumatic brain injury (TBI), we undertook a review to identify the key processes evaluators should follow and the key factors they should consider when completing a vocational evaluation. Processes outlined in the Cochrane Handbook of Systematic Review guided our processes and included: development of review questions, search strategies and selection criteria; quality appraisal; extraction, analysis and data synthesis; drawing conclusions. Four data bases (i.e. Medline; PsychInfo; Embase; The Cochrane Library of Systematic Reviews) were searched for descriptive articles, quantitative and qualitative studies, and nine websites were searched for CPGs (e.g. Scottish Intercollegiate Guideline Network; US National Guideline Clearinghouse; New Zealand Guideline Group). Two reviewers independently appraised methodological quality. Data were extracted into evidence tables which included: study purpose; location; participants; design/method; themes; findings; relevant processes and factors. Directed content analysis was utilized to analyze and synthesize the descriptive process evidence. A constant comparative method was employed to compare study findings in relation to factors associated with successful employment. Results from process and factors syntheses are integrated into the Evidence-based Framework for Vocational Evaluation Following TBI. This framework identifies seven key processes in a vocational evaluation, including: (1) identification of the evaluation purpose and rationale; (2) intake process; (3) assessment of the person; (4) assessment of the environment; (5) assessment of the occupation/job requirements; (6) analysis and synthesis of assessment results; (7) development of evaluation recommendations. Relevant factors are integrated into each key process. This framework outlines the key information evaluators should gather, the domains of the person, environment and occupation they should assess, and elements of rigour they should consider when completing a vocational evaluation and making recommendations for work re-entry following a TBI.
    Journal of Occupational Rehabilitation 09/2011; 21(3):374-94. DOI:10.1007/s10926-010-9282-0 · 2.80 Impact Factor
  • Archives of Physical Medicine and Rehabilitation 10/2010; 91(10). DOI:10.1016/j.apmr.2010.07.037 · 2.44 Impact Factor
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    ABSTRACT: Using a multiple case study design, this article explores the translation process that emerges within Ontario long-term care (LTC) homes with the adoption and implementation of evidence-based clinical practice guidelines (CPGs). Within-organization knowledge translation is referred to as knowledge application. We conducted 28 semi-structured interviews with a range of administrative and care staff within 7 homes differentiated by size, profit status, chain membership, and rural/urban location. We further undertook 7 focus groups at 5 locations, involving a total of 35 senior clinical staff representing 15 homes not involved in earlier structured interviews. The knowledge application process that emerges across our participant organizations is highly complex, iterative, and reliant upon a facility's knowledge application capacity, or absorptive capacity to effect change through learning. Knowledge application capacity underpins the emergence of the application process and the advancement of knowledge through it. We find that different elements of capacity are important to different stages of the knowledge application process. Capacity can pre-exist, or can be acquired. The majority of the capacity elements required for successful knowledge application in the LTC contexts we studied were organizational. It is essential for managers and practitioners therefore to conceptualize and orchestrate knowledge application initiatives at the organization level; organizational leaders (including clinical leaders) have a vital role to play in the success of knowledge application processes.
    Social Science [?] Medicine 02/2010; 70(9):1326-34. DOI:10.1016/j.socscimed.2009.11.028 · 2.56 Impact Factor
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    ABSTRACT: Despite occupational therapists' role in work-related evaluations, there are no guidelines for evaluating clients' work readiness. This study explored how occupational therapists evaluate work readiness following acquired brain injury in order to develop an integrated model of the factors, processes, stakeholders, and contextual elements relevant to this evaluation. Ten occupational therapists with expertise in vocational and brain injury rehabilitation were interviewed. Data were analyzed using grounded theory methods to develop the work readiness evaluation model. This model describes five processes formative to therapists' evaluation: (1) drawing upon diverse sources of information and perspectives; (2) assessing occupational capacity; (3) contextualizing occupational potential; (4) building a shared understanding of work readiness among stakeholders, including, clients, employers, insurers, and rehabilitation teams; and (5) transforming the work readiness question. The model highlights the importance of building a shared understanding amongst stakeholders and provides a provisional framework to guide practice.
    Canadian Journal of Occupational Therapy 10/2009; 76(4):276-84. DOI:10.1177/000841740907600406 · 0.74 Impact Factor
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    ABSTRACT: In the current context of health care, health professionals' accountability obligations may be more extensive than the degree of autonomy that they are permitted to exercise. To date, how professionals fulfil their obligations with regard to this potential for dissonance has not been investigated. The purpose of this Grounded Theory study was to examine how one professional group, occupational therapists, enacted their accountability obligations within their current practice context. Interviews with 21 therapists across three practice sectors in one Canadian province elicited a detailed portrait of the contextual elements within which accountability enactment took place, and a view of the dynamic interplay of these elements with the decision-making involved in fulfilling professional accountabilities. Practitioners moved back and forth between conscious juggling of accountability expectations and more automatically applying tacit practice knowledge. Beyond non-negotiable bottom line commitments to their formal ethical obligations and to retaining autonomy for their clinical recommendations, practitioners' decisions reflected the goal of doing their best. However, participants' efforts to find a balance between satisfactorily fulfilling their obligations and acknowledging the frequently unavoidable reality of contextual constraints elicited inconsistent patterns. The study findings raise concerns about ensuring quality of services and the impact on professionals. Although practitioners have an important role to play in addressing these challenges, other stakeholders, for example, the professional regulatory bodies, also must play a role in creating a coherent accountability framework. Further research is needed to obtain greater understanding of professional accountability enactment across health professions, practice sectors and health jurisdictions, and to explore managerial and professional regulatory bodies' perspectives, roles and responsibilities.
    Social Science [?] Medicine 09/2009; 69(7):1063-71. DOI:10.1016/j.socscimed.2009.07.025 · 2.56 Impact Factor
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    ABSTRACT: Little is known about physical therapists' experiences using research evidence to improve the delivery of stroke rehabilitation. The purpose of this study was to explore how physical therapists use research evidence to update the clinical management of walking rehabilitation after stroke. Specific objectives were to identify physical therapists' clinical questions related to walking rehabilitation, sources of information sought to address these questions, and factors influencing the incorporation of research evidence into practice. Two authors conducted in-depth telephone interviews with 23 physical therapists who treat people with stroke and who had participated in a previous survey on evidence-based practice. Data were analyzed with a constant comparative approach to identify emerging themes. Therapists commonly raised questions about the selection of treatments or outcome measures. Therapists relied foremost on peers for information because of their availability, ease of access, and minimal cost. Participants sought information from research literature themselves or with the help of librarians or students. Research syntheses (eg, systematic reviews) enabled access to a body of research. Older therapists described insufficient computer and search skills. Most participants considered appraisal and application of research findings challenging and identified insufficient time and peer isolation as organizational barriers to the use of research. Physical therapists require efficient access to research syntheses primarily to inform the measurement and treatment of walking limitation after stroke. Continuing education is needed to enhance skills in appraising research findings and applying them to practice. Older therapists require additional training to develop computer and search skills. Peer networks and student internships may optimize the exchange of new knowledge for therapists working in isolation.
    Physical Therapy 04/2009; 89(6):556-68. DOI:10.2522/ptj.20080249 · 3.25 Impact Factor
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    ABSTRACT: A qualitative meta-synthesis is an approach to synthesizing relevant findings from across qualitative studies on a particular topic using methods consistent with qualitative research. Using examples of recently completed qualitative meta-synthesis projects, the purpose of this paper is to present the meta-synthesis approach; highlight the key steps, processes, and issues involved; and demonstrate its potential to advance knowledge about occupation and occupation-based practice. The qualitative meta-synthesis approach allows us to take stock of the current state of knowledge in a given area in order to ensure that we have explored the phenomenon from different perspectives and to begin to push the field forward by allowing us to develop deeper insights and understandings. Despite certain limitations and challenges associated with the approach, qualitative meta-syntheses can provide new knowledge through critical analysis and interpretation to inform client, practitioner, and policy audiences.
    Canadian Journal of Occupational Therapy 01/2009; 75(5):301-8. DOI:10.1177/000841740807500513 · 0.74 Impact Factor
  • Mary Stergiou-Kita, Susan Rappolt
    Archives of Physical Medicine and Rehabilitation 10/2008; 89(10). DOI:10.1016/j.apmr.2008.08.109 · 2.44 Impact Factor
  • Mary Stergiou-Kita, Susan Rappolt
    Archives of Physical Medicine and Rehabilitation 10/2008; 89(10). DOI:10.1016/j.apmr.2008.08.110 · 2.44 Impact Factor
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    David Coburn, Susan Rappolt, Ivy Bourgeault
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    ABSTRACT: Abstract Abstract Though some argue that medical power is declining, others disagree. In particular, Freidson assets that medicine is being restratified with medical elites retaining control over health care though practitioners are losing their individual autonomy to these elites. We use the case of state-medicine relationships in Ontario to examine the restratification thesis. Our findings indicate that the state partially controls medicine through restratification. There is partial state co-option of medical organisations and elites. This case also implies that control over the context of care and over the content of medical practice is not as separate as assumed, that profession-practitioner relationships are increasingly problematic, that the concept of autonomy itself requires theoretical and empirical specification, and that the existence of self-regulatory and representative organisations cannot be equated with actual professional self-regulation. The contingent nature of medical power is underlined.
    Sociology of Health & Illness 06/2008; 19(1):1 - 22. DOI:10.1111/j.1467-9566.1997.tb00013.x · 1.88 Impact Factor
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    ABSTRACT: Within the context of knowledge translation, the disconnect between the results of research and the practice patterns of nursing care providers has not been reported in the context of institutional dementia care practice. Therefore, little is known about how knowledge about best dementia care practice, defined broadly as the person-centered approach, gets used by institutional nursing care providers. Unregulated care providers provide the majority of nursing care for older people with Alzheimer's disease and related disorders living in long-term care facilities. The purpose of this grounded theory study was to explore the process whereby these workers use knowledge about person-centered care in their dementia care practice. Transcribed data from tape-recorded interviews with 20 unregulated care providers among eight long-term care facilities in Ontario, Canada, were coded and categorized at progressively more abstract levels until concepts and the relationships among them were integrated in a middle-range theory of knowledge utilization. The theory of Figuring it Out in the Moment illustrates how unregulated care providers in dementia care settings practice in the context of unpredictability, variability, and personal threat. Their use of knowledge about person-centered care is dependent on the existence of certain individual and relational conditions that interrelate with four separate, but interconnected, phases of clinical decision-making and action. As a middle-range theory, Figuring it Out in the Moment is concrete and pragmatic information for promoting evidence-based dementia care not included in existing overarching knowledge utilization frameworks. Areas for further investigation include how knowledge utilization is conceptualized, as well as the influences of practitioners' clinical decision-making, the nature of caregiving with particular client populations, and the characteristics of individuals alone and in relationship on the utilization of best practice knowledge.
    Worldviews on Evidence-Based Nursing 02/2008; 5(1):13-24. DOI:10.1111/j.1741-6787.2008.00114.x · 2.32 Impact Factor
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    ABSTRACT: The purpose of this study was to identify practitioner barriers (education, attitudes and beliefs, interest and perceived role, and self-efficacy) and organizational barriers (perceived support and resources) to physical therapists' implementation of evidence-based practice (EBP) for people with stroke. The participants were 270 physical therapists providing services to people with stroke in Ontario, Canada. A cross-sectional mail survey was conducted. Only half of respondents had learned the foundations of EBP in their academic preparation or received training in searching or appraising research literature. Although 78% agreed that research findings are useful, 55% agreed that a divide exists between research and practice. Almost all respondents were interested in learning EBP skills; however, 50% indicated that physical therapists should not be responsible for conducting literature reviews. Average self-efficacy ratings were between 50% and 80% for searching and appraising the literature and below 50% for critically appraising psychometric properties and understanding statistical analyses. Despite Internet access at work for 80% of respondents, only 8% were given protected work time to search and appraise the literature. Lack of education, negative perceptions about research and physical therapists' role in EBP, and low self-efficacy to perform EBP activities represent barriers to implementing EBP for people with stroke that can be addressed through continuing education. Organizational provision of access to Web-based resources is likely insufficient to enhance research use by clinicians.
    Physical Therapy 11/2007; 87(10):1284-303. DOI:10.2522/ptj.20070040 · 3.25 Impact Factor
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    ABSTRACT: To assess radiation oncology residents' needs and satisfaction in their first postgraduate year (PGY-1) in the province of Ontario. Of 62 radiation oncology residents, 58 who had completed their PGY-1 and were either enrolled or had graduated in 2006 were invited to participate in a 31-item survey. The questionnaire explored PGY-1 residents' needs and satisfaction in four domains: clinical workload, faculty/learning environment, stress level, and discrimination/harassment. The Fisher's exact and Wilcoxon nonparametric tests were used to determine relationships between covariate items and summary scores. Of 58 eligible residents, 44 (75%) responded. Eighty-four percent of residents felt that their ward and call duties were appropriate. More than 50% of respondents indicated that they often felt isolated from their radiation oncology program. Only 77% agreed that they received adequate feedback, and 40% received sufficient counseling regarding career planning. More than 93% of respondents thought that faculty members had contributed significantly to their learning experience. Approximately 50% of residents experienced excessive stress and inadequate time for leisure or for reading the medical literature. Less than 10% of residents indicated that they had been harassed or experienced discrimination. Eighty-three percent agreed or strongly agreed that their PGY-1 experience had been outstanding. Most Ontario residents were satisfied with their PGY-1 training program. More counseling by radiation oncology faculty members should be offered to help residents with career planning. The residents might also benefit from more exposure to "radiation oncology" and an introduction to stress management strategies.
    International Journal of Radiation OncologyBiologyPhysics 11/2007; 69(2):512-7. DOI:10.1016/j.ijrobp.2007.03.006 · 4.18 Impact Factor
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    ABSTRACT: The Ontario Stroke System was developed to enhance the quality and continuity of stroke care provided across the care continuum. To identify the role evidence played in the development and implementation of the Ontario Stroke System. This study employed a qualitative case study design. In-depth interviews were conducted with six members of the Ontario Stroke System provincial steering committee. Nine focus groups were conducted with: Regional Program Managers, Regional Education Coordinators, and seven acute care teams. To supplement these findings interviews were conducted with eight individuals knowledgeable about national and international models of integrated service delivery. Our analyses identified six themes. The first four themes highlight the use of evidence to support the process of system development and implementation including: 1) informing system development; 2) mobilizing governmental support; 3) getting the system up and running; and 4) integrating services across the continuum of care. The final two themes describe the foundation required to support this process: 1) human capacity and 2) mechanisms to share evidence. This study provides guidance to support the development and implementation of evidence-based models of integrated service delivery.
    International journal of integrated care 02/2007; 7:e30. · 1.26 Impact Factor
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    ABSTRACT: Although the use of reflection to facilitate learning and its application in practice has been widely advocated, there is little empirical research to establish whether or not health professionals use reflection to integrate learning into clinical practice. Particularly troublesome is the lack of empirically based theory underlying strategies to promote reflection and understand factors that influence its use in translating learning into practice. Occupational therapists participated in this case study, in which reflection and implementation of learning from a short course into practice were examined using a multimethod approach. In phase one (n = 41), quantitative data were collected from a practice survey, the Self-Reflection and Insight Scale (SRIS) and Commitment to Change (CTC) statements. In phase two (n = 33), follow-up CTC data were collected to quantify the extent of achievement of CTCs. Data from phases one and two were analyzed descriptively to inform the selection of interview participants (n = 10) in phase three of data collection. Two models were generated. One model describes when reflection was used, and the second model explains factors influencing its use. Participants used reflection before, during, and after the course, and reflection was influenced by a range of factors associated with the course, practice context, and the individual. The theory and models depicting the use of reflection may guide educators' use of reflective learning before, during, and after short courses.
    Journal of Continuing Education in the Health Professions 02/2007; 27(3):143-8. DOI:10.1002/chp.117 · 1.19 Impact Factor

Publication Stats

879 Citations
72.24 Total Impact Points


  • 1997–2013
    • University of Toronto
      • • Joint Centre for Bioethics
      • • Department of Occupational Science and Occupational Therapy
      • • Institute of Health Policy, Management and Evaluation
      • • Department of Rehabilitation Science
      • • Faculty of Medicine
      Toronto, Ontario, Canada