Occupation vs Activity

OT Dude Academy’s Free NBCOT® Exam Prep Course Domain Occupation vs Activity

A summary from the blog post – Occupation vs Activity

Definitions

OTPF

The current definitions as defined in the OTPF-4 are:
Occupation: Everyday personalized activities that people do as individuals, in families, and with communities to occupy time and bring meaning and purpose to life.
Activity: Actions designed and selected to support the development of performance skills and performance patterns to enhance occupational engagement.
 
The previous definitions as defined in the OTPF-3 are:
Occupation: Daily life activities in which people engage. Occupations occur in context and are influenced by the interplay among client factors, performance skills, and performance patterns. Occupations occur over time; have a purpose, meaning, and perceived utility to the client; and can be observed by others (e.g., preparing a meal) or be known only to the person involved (e.g., learning through reading a textbook). Occupations can involve the execution of multiple activities for completion and can result in various outcomes.
Activity: Actions designed and selected to support the development of performance skills and performance patterns to enhance occupational engagement.
 

Additional Definitions of Occupation

  1. Occupation is as necessary to life as food and drink…Sick minds, sick bodies, and sick souls may be healed through occupation. 1 
  2. A person’s personally constructed, one-time experience within a unique context. 2 
  3. Those activities that occupy a person’s time, involve achievement and address the economic realities of life. 3 
  4. The relationship between an occupational form and an occupational performance. Occupational performance means the doing. Occupational form means the thing, or the format, that is done. 4 
  5. Chunks of culturally and personally meaningful activity in which humans engage can be named in the lexicon of our culture. 5 
  6. ‘Doing’ by the individual, is goal-directed, carries meaning for the individual, and is repeatable. 6 
  7. Occupation, that is, purposeful activity, is a central aspect of the human experience. 7 
  8. A general term that refers to engagement in activities, tasks and roles for the purpose of meeting the requirements of living. 8 
  9. Engagement in self-initiated, adaptive, purposeful, culturally relevant, organized activity. 9 

Additional Definitions of Activity

  1. The proper use of gratifying activity appeared to me a fundamental issue in the treatment of any neuro-psychiatric patient. 10 
  2. A more general, culturally shared idea about a category of action. 2 
  3. The observable result of the use of the hands as they are energized by mind and will. 11 

Definitions of Purposeful Activity

  1. The primary tool of the occupational therapist for the remediation of performance areas and performance components is a purposeful activity. The purposefulness of an activity is determined by the context in which it is performed 12 
  2. Goal-directed behaviors or tasks that comprise occupations. An activity is purposeful if the individual is an active, voluntary participant and if the activity is directed toward a goal that the individual considers meaningful. 13 

Summary of Definitions

Term Characteristics Focus Relevance to OT
“Occupation” Meaningful, purposeful Client Central
“Activity” Meaning and relevance absent Practitioner Minimal, Adjunctive
“Purposeful Activity” Purposeful, context absent Society, Practitioner Used within therapy programs
Source: Golledge, J. (1998). Distinguishing between occupation, purposeful activity and activity, part 1: Review and explanation. British Journal of Occupational Therapy, 61(3), 100-105.

Similarities and Differences

Occupation vs Activity

Activities are more general, descriptive categories whose meanings are culturally shared rather than originating with the person. Occupation is unique to a person’s experience, is meaningful to them, and includes their personal and contextual experience as well. Take for example “eating”. As an occupation, it is tied to one’s unique experience that includes their thoughts, mood, the meaning of eating, sensations, social factors, time, place, cultural meaning, and so on. “Eating” can be also described as an activity that one human to another would understand, such as when a couple asks each other if they would like to consider the activity of eating.

However, your experience with eating breakfast this morning was an occupation that is different than mine, even if we both sat next to each other and participated in the activity of eating. Example 2: Shopping as an activity is a culturally shared general idea about doing. However, to me, shopping is not a meaningful activity that I would prefer to engage in compared to someone who likes to shop. If I was a patient and the OT practiced shopping with me, it would merely be an activity, maybe a purposeful one (as I practiced physically retrieving an item from a shelf for my range of motion and coordination), but at the end of the day, it was not a meaningful occupation.

“The important influence of the physical, social and cultural environment is not evident in the application of activities, yet this is a crucial aspect that sets our professional practice apart from that of other health care professionals.” 14 

This is a good reminder that although we classify and organize and label occupations, e.g., in the OTPF, not all occupations are “occupations” to everyone, only if they are meaningful to them. Not even purposeful, but meaningful. And that should be an important consideration when occupational therapy practitioners aim to be client-centered and promote a client’s engagement in occupation – it should be meaningful to them. This is why activities (e.g., preparatory activities, or even purposeful activities) when performed in isolation without occupation are not considered occupational therapy intervention by modern-day practitioners.

Activity vs Purposeful Activity

An activity is not necessarily purposeful. For example, an occupational therapy practitioner may fabricate a splint for a client. However, this is passive for the client and they do not achieve anything purposeful, even if the occupational therapy intends for the splint to achieve a purpose. The difference here is engagement, active vs. passive, and whether the client fulfills a purpose. A client who practices fine motor skills with board game pieces may be doing an activity, but if they are not playing the actual game with the rules, it is not purposeful. Would the client who plays the board game be considered doing an occupation? It depends. Is this board game meaningful to the client, or are they playing just because the OT suggested it and they are not having any fun or enjoyment from it (if the purpose of the board game by the OT was for leisure)?

Occupation vs Purposeful Activity

According to Pedretti, purposeful activity has been at the core of OT since its inception. 12  Although purposeful activity may appear to be the same as occupation, purposeful activity does not consider the context, e.g., environment. Another differentiation between occupation and purposeful activity as mentioned in the board game example is occupation is meaningful to the client, while purposeful activity may simply be purposeful, e.g, achieving a task, but is not meaningful to the client.

Activity is Still Important

  • “Activity is a common sense word that serves quite well for communicating in a simple, general way”.
  • “Activity is an area of expertise with which occupational therapy has long been associated” (and activity analysis too).
  • As activity is tied to culture and its ideas, occupational therapy practitioners will need to constantly research and update interventions to be relevant, effective, and functional.
  • “Activity is also used in important ways in the health care system within definitions of billable service, assessments of function and degree of disablement, and even the naming of entire fields.” 2 
  • Activity may be necessary for recovery and function, e.g., splinting, PAMs, using the bathroom.
  • Occupational therapy plays a role in rehabilitation and recovery with activities for health, wellness, and return to daily functioning.

Putting It All Into OT Practice

  • Use a top-down approach in addition to or instead of a bottom-up approach.
  • Collaborate with the client and be client-centered.
  • In addition to activities (e.g., preparatory) and purposeful activities, always try to promote occupation.
  • Consider the client’s context, culture, and social participation to promote occupation.
  • Activity is not bad, but occupation should be the means and the goal.
  • Avoid diversional activities. These are considered valueless, not engaging, meaningful, or skill-based, e.g., an activity directory or aide may fulfill this role.
  • Be careful when imposing purposeful activities with clients or a group of clients, e.g., even in mental health.
  • While disease focus (bottom-up) may be desired, aspects of the symptom or barriers should be addressed with the client to find meaning (top-down) to avoid completing activities in the session.
  • Therapeutic use of common medium or tools, e.g, theraputty, stacking cones, art, and crafts, may all be activities (maybe even purposeful), but without meaning, it is not occupation or occupational therapy intervention.
  • Participation in ADLs (while very common, expected, and covered by insurance, or important), may not necessarily be the priority or goal of the client. This would merely be a purposeful activity and not their occupation due to the lack of meaning.
  • Educate clients, colleagues, health professionals, insurance, families, the general public, and relevant stakeholders about the terminology, purpose, and value of the profession.
  • While it may be tempting to use the best EBP, evaluate whether the intervention is occupational or if there can be ways to incorporate it. For example, CIMT and mirror therapy have strong evidence for stroke rehabilitation, but how can it be made occupational and not just be an activity? If the client likes basketball, for example, then they can participate in an occupational basketball game using CIMT by engaging their involved extremity to throw a ball in a basket. However, if the same activity is used with someone who is not interested in basketball, it is merely an activity, despite it helping improve their function in rehab.
  • Use OT’s unique approaches and methods to promote occupation: building an occupational profile, using a top-down approach, e.g., PEO-P, MOHO, and real-world participation in occupations in a context that is meaningful to the client.
     
 
  1. Dunton, W. R. (1919). Reconstruction therapy. Philadelphia: Saunders.[↩]
  2. Pierce, D. (2001). Untangling occupation and activity. American Journal of Occupational Therapy, 55, 138–146.[↩][↩][↩]
  3. Barrett, L., & Kielhofner, G. (1998). Theories derived from occupational behavior perspectives. In M. Neistadt & E. Crepeau (Eds.), Willard and Spackman’s occupational therapy (9th ed., pp. 525–535). Philadelphia: Lippincott.[↩]
  4. Nelson, D. L. (1997). Why the profession of occupational therapy will flourish in the 21st century, 1996 Eleanor Clarke Slagle lecture. American Journal of Occupational Therapy, 51, 11–24.[↩]
  5. Clark, F. A., Parham, D., Carlson, M. E., Frank, G., Jackson, J., Pierce, D., Wolfe, R. J., & Zemke, R. (1991). Occupational science: Academic innovation in the service of occupational therapy’s future. American Journal of Occupational Therapy, 45, 300–310.[↩]
  6. Gray, J. (1997). A phenomenological perspective on occupation. Journal of Occupational Science: Australia, 4, 5–17.[↩]
  7. Wilcock A (1993) A theory of the human need for occupation. Occupational Science: Australia, 1(1), 17-24.[↩]
  8. Levine RE, Brayley CR (1991) Occupation as a therapeutic medium. In: C Christiansen, C Baum, eds. Occupational therapy: overcoming human performance deficits. NewJersey: Slack.[↩]
  9. Yerxa EJ (1994) Dreams, dilemmas and decisions for occupational therapy practice in a new millennium: an American perspective. American Journal of Occupational Therapy, 48(7), 586-89.[↩]
  10. Meyer, A. (1922). The philosophy of occupational therapy. Archives of Occupational Therapy, 1, 1–10.[↩]
  11. Cynkin, S. (1995). Activities. In C. Royeen (Ed.), The practice of the future: Putting occupation back into therapy (pp. 7-1–7-52). Bethesda, MD: American Occupational Therapy Association.[↩]
  12. Pedretti LW (1996) Occupational performance: a model for practice in physical dysfunction. In: LW Pedretti, ed. Occupational therapy: practice skills for physical dysfunction. 4th ed. St Louis: Mosby.[↩][↩]
  13. AOTA(1993) Position paper: purposeful activity. American Journal of OccupationalTherapy, 47(12), 1081-82.[↩]
  14. Golledge, J. (1998). Distinguishing between occupation, purposeful activity and activity, part 1: Review and explanation. British Journal of Occupational Therapy, 61(3), 100-105.[↩]
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