Occupational therapy theory, practice and research has increasingly emphasized the transactional relationship between person, environment and occupation. Occupational performance results from the dynamic relationship between people, their occupations and roles, and the environments in which they live, work and play. There have, however, been few models of practice in the occupational therapy literature which discuss the theoretical and clinical applications of person-environment interaction. This paper proposes a Person-Environment-Occupation Model of occupational performance which builds on concepts from the Occupational Therapy Guidelines for Client Centered Practice and from environment-behaviour theories. The model describes interactions between person, occupation and environment, outlines major concepts and assumptions, and is applied to a practice situation.

Objective. This ethnographic study examined what makes work meaningfULfOr persons with persistent mental illness and how this meaningfUlness relates to their recovery.Method. Twelve persons between 32 and 58 years of age who had been involved an average of19 years with a fOrmal mental health system participated in in-depth interviews and a fOcus group. Thematic analysis and case studies were understood in the context ofthe investigator's 15 months ofparticipant observation of35 persons with psychiatric disabilities working at an affirmative business.Results. The meaning ofwork varied with participants'perception oftheir illness and their seLfconcept. Changes in their seLfefficacy and seLfconcept were driven by their participation in work activities to operate the affirmative business.Conclusion. Findings suggest that therapists could potentially ftcilitate these changes in clients'sense ofselfefficacy and self-concept by helping them make connections with meaningful occupations and contributions to organizations in the community and to experience challenges and successes in the context ofmeaningful work.

Occupational therapy focuses on complex dynamic relationships between people, occupations and environments. Therapists must clearly communicate their practices and how their practice influences outcomes. This paper explores applications of the Person-Environment-Occupation Model (Law et al., 1996) in occupational therapy practice, and delineates how this particular model helps therapists to conceptualize, plan, communicate and evaluate occupational performance interventions. Three case studies illustrate how the model can be used by occupational therapists to systematically approach analysis of occupational performance issues while considering the complexities of human functioning and experience. The ways in which the model facilitates communication within and outside occupational therapy are explained. The Person-Environment-Occupation Model is offered as a tool for therapists to use in client(s)-therapist alliances to enable clients to successfully engage in meaningful occupations in chosen environments.

Background: Among clinical trial patients at high surgical risk, a model has been developed and externally validated to estimate patient risk for poor outcomes after transcatheter aortic valve replacement (TAVR). How this model performs in lower risk and unselected patients is not known. We sought to examine and optimize the performance of the TAVR Poor Outcome Risk Model among patients in the US Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry. Methods and Results: Among 13,351 patients who underwent TAVR at 252 US sites between November 9, 2011-June 30, 2015, the rate of poor outcome at 1 year after TAVR was 38.9%, which was due to death in 20.7% and poor quality of life or quality of life decline in 18.2%. The rate of poor outcome has decreased slightly over time, from 42.0% in 2012 to 37.8% in 2015 (p for trend=0.076). The original TAVR Poor Outcome risk model did not calibrate well on this population. We then re-estimated the intercept and coefficients in the model and retested model performance, after which it performed well (both overall and in sub-groups), with a c-index 0.65 and excellent calibration. Conclusions: In a large cohort of unselected patients in the US, we found that while a substantial minority of patients continue to have a poor outcome after TAVR, outcomes have slowly improved over time. After recalibration, the TAVR Poor Outcome Risk Model performed well. This model could potentially be used prior to TAVR to help patients have appropriate expectations of recovery.