A Century of Therapeutic Use of the Physical Environment of Occupation to Influence Health

The purpose of this study was to describe the therapeutic use of the physical context of occupation over the history of occupational therapy. Documenting century-long patterns in therapists\u27 creation, use, and alteration of the objects and spaces of occupation to influence health strengthens understandings of the physical context of occupation and the way in which occupational science research supports occupational therapy. This study used grounded theory methods to analyze historical occupational therapy literature, including documents archived at the Wilma West Library, the Willard and Spackman\u27s Occupational Therapy series, and the American Journal of Occupational Therapy. The sample of 75 pieces of literature was selected for its focus on the role of the physical environment in intervention, and to represent a variety of settings and populations. Coding, collaborative critical analysis, memo writing, and visual modeling were used throughout the analysis sequence, which included expert audio interview, initial coding scheme, code pilot, chronological analysis of data across all time periods from 1910s to 2000s, code revision, theoretical sampling, and theoretical saturation. Significant transformations of categories, as well as the discovery of new concepts, indicates the degree to which this grounded theory research was trustworthy. The substantive descriptive theory produced by the study will be presented, including a typology of human-object interactions, the evolution of two related key concepts from the earliest to the latest periods, and historical changes in the ways in which therapists occupied intervention spaces. A four-square typology of human-object interactions describes either constructive or non-constructive activities, completed by either therapists or clients, as well as historical changes in the objects and therapeutic activities utilized within each type. Increasing diversity and complexity in therapists\u27 entry, creation, negotiation, and expansion of treatment space from early years to the present will be described. Professional use of the physical environment of occupation to influence health has, across the century, a fractal, self-referencing nature. Adaptation and grading of objects and activities by therapists was a strange attractor: ever-present but differently expressed throughout history. Together, these findings describe the subtle spatial gift of occupational therapists, expressed in their historical management of the physical environment