How does occupational therapy literature conceptualise executive functions and how this influences occupational therapy assessment? An integrative review

Abstract

Background:

Occupational therapists (OT) are commonly tasked with assessing the functional impact of an executive dysfunctional following a brain injury. Research has highlighted uncertainty in the literature regarding how this phenomenon is understood in occupational therapy.

Purpose:

To explore the conceptual understanding of executive function in OT literature and how this influences the professions approach to assessment.

Method:

An integrative review of 13 studies was completed using thematic analysis to generate themes in the literature.

Results:

Four themes were generated: (1) There is inconsistency in our working definition of executive functions (EF) and what constitutes a component (2) EF is conceptualised in singular complex tasks in the OT literature, (3) There is uncertainty on the accuracy of assessing EF performance in one-off tasks (4) There is uncertainty about what constitutes normal EF performance in an occupation.

Conclusions:

This integrative review identifies challenges in the conceptualisation and assessment of executive functions within OT. Inconsistent definitions, reliance on neuropsychological frameworks and standardised assessments, such as the multiple-errands test and executive function performance test, fail to capture the complex and individualised nature of occupational performance. The limited integration of occupational science further hampers the development of OT-specific approaches. Clearer definitions and qualitative research would enable advancements in practice and enhance client-centred interventions.