Occupational therapy practice framework: domain & practice, 2nd edition

Impact of mHealth technology on adherence to healthy PA after stroke: a randomized study

BACKGROUND

Physical activity (PA) is a key health behavior in people with stroke including risk reduction of recurrent stroke. Despite the beneficial effects of PA, many community-dwelling stroke survivors are physically inactive. Information and communication technologies are emerging as a possible method to promote adherence to PA.

OBJECTIVE

The aim of this study is to investigate the effectiveness of a mobile-health (mHealth) App in improving levels of PA.

METHODS

Forty-one chronic stroke survivors were randomized into an intervention group (IG) n=24 and a control group (CG) n=17. Participants in the IG were engaged in the Multimodal Rehabilitation Program (MMRP) that consisted on supervising adherence to PA through a mHealth app, participating in an 8-week rehabilitation program that included: aerobic, task-oriented, balance and stretching exercises. Participants also performed an ambulation program at home. The CG received a conventional rehabilitation program. Outcome variables were: adherence to PA, (walking and sitting time/day), walking speed (10MWT); walking endurance (6MWT); risk of falling (TUG); ADLs (Barthel); QoL (Eq-5D5L) and participant's satisfaction.

RESULTS

At the end of the intervention, community ambulation increased more in IG (38.95 min; SD: 20.37) than in the CG (9.47 min; SD: 12.11) (p≤.05). Sitting time was reduced by 2.96 (SD 2.0) hours/day in the IG and by 0.53 (SD 0.24) hours in the CG (p≤.05).

CONCLUSIONS

The results suggest that mHealth technology provides a novel way to promote adherence to home exercise programs post stroke. However, frequent support and guidance of caregiver is required to ensure the use of mobile devices.

Opening the horizons of clinical reasoning to qualitative research

Clinical Reasoning (CR) is an important aspect of health professional education and effective practice. It is a complex series of factors and cognitive functions, involving higher-level thinking to define problems, examine the evidence and then making decisions and choices to improve the patient's physiological and psycho-social state.CR consists of 3 interconnected and interdependent sub-processes: clinical experience and clinical context and Evidence-Based Practice. This essay focuses on the opportunities that Qualitative Research offers during the CR process when the doctor finds the evidence to address a patient's health problem. Clinicians are often faced with questions that randomized clinical trials or systematic reviews of efficacy studies cannot answer. For this reason, we considered it necessary to offer an expanded view of the process of interpretation of the scientific literature used in daily clinical practice through the complex process of Clinical Reasoning, through the use of studies conducted with qualitative methods, which are able to respond to a different range of clinical questions, and to support studies based on the effectiveness of treatments.

Health promotion, wellness, and prevention in hand therapy: A survey study

STUDY DESIGN

Descriptive study.

INTRODUCTION

Noncommunicable diseases including diabetes and cardiovascular disease are associated with increased complications and cost of health care.

PURPOSE OF THE STUDY

To describe beliefs and extent to which hand therapists include health promotion, wellness, and prevention (HPWP) in practice and to elucidate barriers to the incorporation of HPWP.

METHODS

A 38-question survey evaluating hand therapists' beliefs, practice of HPWP, and barriers was sent to American Society of Hand Therapists members.

RESULTS

About 270 American Society of Hand Therapists members participated. Respondents believed they had a role in HPWP, including occupational (95%), physical (92%), emotional (87%), and psychological (84%) factors and instrumental activities of daily living management (98%). Physical activity is most frequently addressed (42%), whereas other health behaviors are rarely addressed. Time, patient interest, and resources were among identified barriers.

DISCUSSION

The importance of health promotion and disease prevention practice is being recognized as critical to successful health outcomes.

CONCLUSION

The study results suggest the need to develop HPWP educational programming for hand therapists and the need to consider expansion of understanding of HPWP initiatives and subsequent benefits to patients.

LEVEL OF EVIDENCE

5.

Inter-sectoral work practice in Zimbabwe: Professional competencies required by occupational therapists to facilitate work participation of persons with disabilities

BACKGROUND

Persons with disabilities experience higher unemployment rates and limited participation in work. Occupational therapy can promote participation and engagement in work by persons with disabilities. However, there is no clarity on the required set of competencies for entry-level occupational therapists with a bachelor's degree to start up and participate in inter-sectoral work practice initiatives in Zimbabwe.

AIMS

To explore what work practice competencies entry-level occupational therapists require to meet the work-related needs of persons with disabilities.

MATERIAL AND METHODS

This exploratory qualitative research sought to explore what professional competencies entry-level occupational therapists required for them to offer collaborative inter-sectoral work practice initiatives for persons with disabilities within the Zimbabwean context. Six participants selected using criterion sampling, participated in semi-structured interviews. Inductive content analysis was conducted. The Stellenbosch Health Research Ethics Committee and Medical Rehabilitation Practitioner's Council of Zimbabwe gave ethical clearance and permissions to conduct the study.

RESULTS

Three themes; core knowledge for work practice, skills for work practice and occupational therapy professional attributes; emerged. These were used in formulation of ten professional competency statements for occupational therapists offering work practice services.

CONCLUSIONS

Although Zimbabwean occupational therapists require similar competencies for work practice as those required in other countries, additional competencies that fall outside traditional health care contexts are essential in order to promote contextually relevant practice.

The Role of Occupational Therapy in Secondary Prevention of Diabetes

Diabetes mellitus is becoming a global health concern due to its prevalence and projected growth. Despite a growing number of interventions for secondary prevention of diabetes, there is a persistent poor glycemic control and poor adherence to the prescribed diabetes management regimen. In light of the tremendous costs of diabetes to both individuals and the society, it is pressing to find effective ways to improve diabetes self-management (DSM) and treatment adherence. Occupational therapists can bring values to the diabetes care team by evaluating multiple levels of influence on DSM, addressing personal and environmental barriers to well-being and DSM, and supporting patients to develop of a highly complex competences and skills to satisfactorily self-manage diabetes. This article summarizes two evidence-based, well-structured occupational therapy (OT) programs that use activity-based treatments and psychosocial strategies, respectively, to improve DSM abilities and to enhance quality of life. As the needs of adolescents with diabetes are quite different from other diabetic populations, this article also provides a summary of pediatric OT interventions that aim to facilitate autonomy and development of DSM ability among adolescents with diabetes. Evidence indicates that OT interventions can improve the quality of life and treatment adherence in patients with diabetes and hence should be continued and built on to address the increasing needs of diabetic populations.

Biomimetic sensory feedback through peripheral nerve stimulation improves dexterous use of a bionic hand

We describe use of a bidirectional neuromyoelectric prosthetic hand that conveys biomimetic sensory feedback. Electromyographic recordings from residual arm muscles were decoded to provide independent and proportional control of a six-DOF prosthetic hand and wrist-the DEKA LUKE arm. Activation of contact sensors on the prosthesis resulted in intraneural microstimulation of residual sensory nerve fibers through chronically implanted Utah Slanted Electrode Arrays, thereby evoking tactile percepts on the phantom hand. With sensory feedback enabled, the participant exhibited greater precision in grip force and was better able to handle fragile objects. With active exploration, the participant was also able to distinguish between small and large objects and between soft and hard ones. When the sensory feedback was biomimetic-designed to mimic natural sensory signals-the participant was able to identify the objects significantly faster than with the use of traditional encoding algorithms that depended on only the present stimulus intensity. Thus, artificial touch can be sculpted by patterning the sensory feedback, and biologically inspired patterns elicit more interpretable and useful percepts.

Egocentric video: a new tool for capturing hand use of individuals with spinal cord injury at home

Background

Current upper extremity outcome measures for persons with cervical spinal cord injury (cSCI) lack the ability to directly collect quantitative information in home and community environments. A wearable first-person (egocentric) camera system is presented that aims to monitor functional hand use outside of clinical settings.

Methods

The system is based on computer vision algorithms that detect the hand, segment the hand outline, distinguish the user’s left or right hand, and detect functional interactions of the hand with objects during activities of daily living. The algorithm was evaluated using egocentric video recordings from 9 participants with cSCI, obtained in a home simulation laboratory. The system produces a binary hand-object interaction decision for each video frame, based on features reflecting motion cues of the hand, hand shape and colour characteristics of the scene.

Results

The output from the algorithm was compared with a manual labelling of the video, yielding F1-scores of 0.74 ± 0.15 for the left hand and 0.73 ± 0.15 for the right hand. From the resulting frame-by-frame binary data, functional hand use measures were extracted: the amount of total interaction as a percentage of testing time, the average duration of interactions in seconds, and the number of interactions per hour. Moderate and significant correlations were found when comparing these output measures to the results of the manual labelling, with ρ = 0.40, 0.54 and 0.55 respectively.

Conclusions

These results demonstrate the potential of a wearable egocentric camera for capturing quantitative measures of hand use at home.

Measurement Validity of the Low Vision Independence Measure (LVIM)

OBJECTIVE

This study's objective was to test the psychometrics of Smith's (2013) Low Vision Independence Measure (LVIM) using the Rasch model.

METHOD

A cohort design was used with 93 participants receiving occupational therapy for low vision. Confirmatory factor analysis (CFA) with a parceling approach was used to test the LVIM factors and Rasch analysis to examine item-level psychometrics.

RESULTS

Participants' average age was 78.9 yr (standard deviation = 12.1), and the majority were female (72.8%) with macular degeneration (62.3%). The CFA revealed two measurement factors: visual field or scotoma (n = 28) and visual acuity (n = 24). We removed six misfitting items, and the two factors of the revised LVIM demonstrated good rating scale function, good internal consistency (person reliability: visual field, .87; visual acuity, .90), good precision (person strata: visual field, 3.91; visual acuity, 4.40), no ceiling or floor effects, and no differential item functioning.

CONCLUSION

The revised LVIM demonstrates good psychometrics on the Rasch model and can be used as a valid outcome measure in low vision rehabilitation.

Assistive technology based on client-centered for occupational performance in neuromuscular conditions

Knowledge of the patient's own perception of functioning and dependence, and of environmental factors, is of significant value. The main goals of this study are (1) to obtain a general profile of the occupational performance of persons with neuromuscular disorders (NMD) and their needs related to that performance and (2) to determine the support resources (assistive technologies [AT], adjustment, and/or caregiver) required to improve or maintain their level of independence.This cross-sectional study involved 24 persons with NMD. The functional independence measure (FIM), the checklist of a home's accessibility level, and a specific questionnaire were administered.The sample included 14 women (58.3%) and 10 men (41.7%). A mean of 61.7 (standard deviation = 17.2) was obtained for FIM motor, over 91, indicating a moderate level of dependence. The AT most frequently used was a wheelchair (70.8%). Architectural barriers were detected in the majority of users' homes (87.5%).Concise assessment of the independence needs of people with NMD, according to their occupational performance, and prescription of resources to meet those needs are required. This procedure should be implemented in healthcare programs, including care to a caregiver.

Walking speed as a predictor of community mobility and quality of life after stroke

Background: Community mobility (CM) is considered a part of community reintegration that enhances Quality of Life (QoL). Achieving an appropriate gait speed is essential in attaining an independent outdoor ambulation and satisfactory CM. Objective: The aim of this study was to identify whether gait speed is a predictor of CM and QoL in patients with stroke following a multimodal rehabilitation program (MRP). Methods: This was a baseline control trial with 6-months follow-up in an outpatient rehabilitation setting at a university hospital. Twenty-six stroke survivors completed the MRP (24 sessions, 2 days/wk, 1 hr/session). The MRP consisted of aerobic exercise, task-oriented exercises, balance exercises and stretching. Participants also performed an ambulation program at home. Outcome variables were: walking speed (10-m walking test) and QoL (physical and psychosocial domains of Euroquol and Sickness Impact Profile). Results: At the end of the intervention, comfortable and fast walking speed increased by an average of 0.16 (SD 0.21) (*p < .05) and 0.40 (SD 0.51) (**p < .001) m/s, respectively. After the intervention, all participants achieved independent outdoor ambulation with an increase of 34.14 of walking minutes/day in the community and a decrease of sitting time of 95.45 minutes/day. Regarding QoL there were increased mean scores on the physical and psychosocial dimensions of Euroquol and the Sickness Impact Profile, respectively (**p < .001). Conclusions: The results suggest that improved walking speed after the MRP is associated with CM and higher scores in QoL. These findings support the need to implement rehabilitation programs to promote increased speed.

Evaluation of the content coverage of questionnaires containing basic and instrumental activities of daily living (ADL) used in adult patients with brain tumors

Background

Everyday functioning can be assessed using measures of basic activities of daily living (BADL) or instrumental activities of daily living (IADL). The aim of this review was to provide an overview of the scope and specific content of BADL and/or IADL covered by currently used questionnaires in adult brain tumor patient studies.

Methods

Electronic databases were searched up to April 2017 to identify all eligible questionnaires with items regarding BADL/IADL in studies with adult brain tumor patients. Articles were selected using predetermined in- and exclusion criteria. Items with similar content were clustered into domains based on type of activity.

Results

Thirty-one unique questionnaires containing at least one BADL and/or IADL item were identified; 21 and 29 questionnaires containing ≥ 1 BADL or IADL item, respectively. The percentage of ADL items in these questionnaires ranged from 4 to 100%. Only two questionnaires were specifically developed to measure BADL (Barthel Index and Katz-ADL) and two specifically for IADL (Lawton-Brody IADL and preliminary IADL-BN). Content clustering revealed that IADL had a larger variation in content (31 domains, e.g. work or leisure time activities) compared to BADL (15 domains, e.g. mobility or bathing/washing).

Conclusion

Thirty-one questionnaires previously used in brain tumor studies contained items on BADL and/or IADL and covered a wide range of content, in particular for IADL. It is currently unclear which BADL/IADL are most relevant for brain tumor patients, and this should therefore be evaluated. Next, existing questionnaires could be adapted or validated, or new measures can be developed to meet these needs.

Electronic supplementary material

The online version of this article (10.1007/s11060-019-03136-9) contains supplementary material, which is available to authorized users.

How Using the Term "Non-Compliant" Keeps Providers From Partnering With Patients

The aim of this article is to offer an alternate perspective for nurses to consider when assigning the label "non-compliant" to a patient. This discussion contains three examples of experiences of people who were designated non-compliant patients, and how they were then thought of as problems, and a fourth example in which the patient's autonomy was respected. The unintended negative consequences of labeling people as non-compliant are examined through the lens of three ethical principles: (a) respect for autonomy, (b) beneficence, and (c) non-maleficence.

Assessment and treatment of pediatric behavioral sleep disorders in Canada

OBJECTIVES/BACKGROUND

This paper outlines the current state of Canadian training, clinical services, research, and advocacy initiatives related to non-respiratory sleep disorders, with a specific focus on insomnia, the most common sleep problem in children.

METHODS

Information for this narrative review was collected from peer-reviewed publications, web-resources, and personal communications and experiences.

RESULTS

It is estimated that approximately one-third of Canadian children and youth present with insomnia, and that this is impacting their physical and mental health, as well as learning in school. Training in pediatric sleep is limited and highly inconsistent within and across disciplines. While there are some publicly and privately funded pediatric sleep services available, these are mostly focused on respiratory sleep problems and are not equally accessible across the country.

CONCLUSIONS

Pediatric assessment and treatment services for non-respiratory sleep disorders needs to be more integrated into the Canadian health care system.

Self-reported health conditions and related driving reduction in older drivers

We surveyed self-reported lifetime health conditions (using National Health and Aging Trends Study questions) and related driving reduction in a large multi-site older driver cohort (n = 2990) from the AAA Longitudinal Research on Aging Drivers (LongROAD) Study's baseline assessment. Those reporting reduced driving (n = 337) largely attributed reduction to musculoskeletal (29%), neurologic (13%), and ophthalmologic (10%) conditions. Women reported health condition-related driving reduction more often than men (14% versus 8%, p<.001). Mobility affects well-being; health professionals should consider that health conditions may cause older adults to reduce driving. Gender differences deserve attention in future research and education efforts.

Effectiveness of the Community–Academia Student Tutoring (CAST) program in enhancing students’ practice placement readiness

Introduction

Occupational therapy programs include practice education, which is a vital aspect of professional practice preparation. We evaluated the effectiveness of the Community–Academia Student Tutoring program for enhancing occupational therapy students’ perceived readiness for their practice placement, thus reducing their feelings of anxiety.

Method

The study included 84 first-year undergraduate occupational therapy students aged 21–35 years, of whom 43 participated in the Community–Academia Student Tutoring group program and the rest comprised the control group. Participants completed the Student Self-Competency and Readiness for Fieldwork questionnaire prior to their first practice placement.

Findings

Anxiety was related to the Student Self-Competency and Readiness for Fieldwork’s components and total score. The Community–Academia Student Tutoring group scored significantly higher ( p < .05) than the controls in the Evaluation and Communication with Patients components of the questionnaire, after controlling for anxiety level.

Implications

It appears that it is possible to enhance students’ readiness for their practice placement through a structured and intensive community-based mentoring program that is guided by faculty and includes activities of briefing and debriefing, such as the Community–Academia Student Tutoring program.

Improving medication adherence in the pediatric population using integrated care of companion animals

Medication non-adherence occurs in more than half of children with chronic conditions. Unfortunately, most strategies for improving adherence have had limited success in the pediatric population highlighting the need for novel interventions that establish healthy self-management habits for children and adolescents. In this paper we discuss innovative strategies to improve adherence by embedding a medical regimen within a pet care routine, thereby capitalizing on the benefits of a structured habit while providing opportunities for development of autonomy in children and fostering collaborative parent interactions.

Examining how context change foster service innovation

Purpose

The purpose of this paper is to explore the role of context in service innovation by developing a conceptual framework that illuminates the key elements and trends in context change.

Design/methodology/approach

The paper adopts a service ecosystem lens for understanding how elements and trends in context foster service innovation. A conceptual framework identifying the role of context change in fostering service innovation is developed and justified through illustrations across industry settings of health, retailing, banking and education.

Findings

Context change is conceptualized by three trends – speed, granularity and liquification – that provide an analytical foundation for understanding how changes in the elements of context – space, resources and institutional arrangements – can foster service innovation. The analysis indicates emerging patterns across industries that allow exploring scenarios, grounded in emerging trends and developments in service innovation toward 2050.

Practical implications

Managers are offered a framework to guide service innovation and help them prepare for the future. The paper also suggests areas for further research.

Originality/value

The paper contributes with a new conceptualization of context change to identify and explain service innovation opportunities. Managers are offered a framework to guide service innovation and help them prepare for 2050. The paper also suggests areas for further service innovation research, zooming in on contextual changes to prepare for 2050.

The experiences of social and community participation of people with non-traumatic spinal cord injury

BACKGROUND/AIM

Incidence of non-traumatic spinal cord injury in Australia is increasing, which will result in more occupational therapists being involved in the rehabilitation of this group in the future. The profile of people with non-traumatic spinal cord injury differs from people with traumatically acquired spinal cord injuries, and their long-term health and well-being outcomes are not known. The aim of this study was to explore the experience of returning to social and community participation following non-traumatic spinal cord injury.

METHODS

Qualitative methods were used for this study. Semi-structured interviews were conducted with seventeen people with non-traumatic spinal cord injury who had returned home. Data were analysed inductively utilising the thematic analysis method.

RESULTS

The process of returning to social and community participation following non-traumatic spinal cord injury was identified as occurring in three main stages: withdrawal; re-emergence into society; and stability. Each stage consisted of adjustment and adaptation in a number of areas, including: the loss of independence; the experience of being out in public; social networks; participation in productivity roles; and expectations regarding satisfactory social and community participation. Many of the participants had developed or were developing strategies to adapt to the changes experienced in these stages.

CONCLUSION

By using a qualitative approach, this study adds to the understanding of the adjustment process experienced by people following non-traumatic spinal cord injury when they return to living in the community. Although findings parallel those of studies conducted with people with TSCI, there are some differences that may warrant alternative approaches from occupational therapists working with people with NTSCI. Such approaches include assisting people with NTSCI to modify their expectations regarding how they will participate in the community, assisting them to find new meaningful roles, and facilitating the development of new social networks to replace lost ones.

Correlation between Leisure Activity Time and Life Satisfaction: Based on KOSTAT Time Use Survey Data

RATIONALE

This study aims to investigate the correlation between the available leisure activity time and life satisfaction of the healthy elderly and the factors affecting them.

METHOD

For the analysis, data from the 2014 Time Use Survey (2014TUS) published by Statistics Korea (KOSTAT) was used. This study classified the detailed activities of 9228 subjects, based on the data in 2014TUS, and analyzed the differences in time use for occupation domains by age group.

RESULTS

It was found that a greater amount time used for outdoor leisure activities yielded a higher life satisfaction value. Differences were found in time use by occupation domains between younger and older groups. These showed higher life satisfaction for those with spouses, regular full-time jobs, higher education, and better health.

CONCLUSION

Based on these results, in order to improve the quality of life (QoL) for older adults, it is necessary to develop various leisure programs that require dynamic physical activities and to prepare alternative policies at the national level to promote participation in leisure activities by older adults. This study will provide occupational therapists (OTs) with data they can use to help older adults who have difficulty in time usage through time management intervention to improve their life satisfaction and QoL.

A sequence-to-sequence model-based deep learning approach for recognizing activity of daily living for senior care

Ensuring the health and safety of independent-living senior citizens is a growing societal concern. Researchers have developed sensor based systems to monitor senior citizens' Activity of Daily Living (ADL), a set of daily activities that can indicate their self-caring ability. However, most ADL monitoring systems are designed for one specific sensor modality, resulting in less generalizable models that is not flexible to account variations in real-life monitoring settings. Current classic machine learning and deep learning methods do not provide a generalizable solution to recognize complex ADLs for different sensor settings. This study proposes a novel Sequence-to-Sequence model based deep-learning framework to recognize complex ADLs leveraging an activity state representation. The proposed activity state representation integrated motion and environment sensor data without labor-intense feature engineering. We evaluated our proposed framework against several state-of-the-art machine learning and deep learning benchmarks. Overall, our approach outperformed baselines in most performance metrics, accurately recognized complex ADLs from different types of sensor input. This framework can generalize to different sensor settings and provide a viable approach to understand senior citizen's daily activity patterns with smart home health monitoring systems.

The Effectiveness of a Knowledge Translation Cognitive-Educational Intervention for Family Members of Persons Coping with Severe Mental Illness

Keshet, a course for family members of persons' coping with mental illness, was developed to enhance positive family cognitive communication skills. Improving communication with the use of mediation techniques, primarily used by therapists, creates a learning environment viewed as a strategy of Knowledge Translation. To examine the effectiveness of Keshet in improving attitudes, problem solving, communication skills and attenuation of burden a quasi-experimental research design was applied with study and control condition. The same group of participants (N = 38) completed questionnaires at different stages: 3 months prior to course, initiation and completion. Following participation, significant changes were observed in attitudes regarding knowledge of how to cope and interact with family member. A correlation was found between improved knowledge and decline in burden. Implementing interventions which provide caregivers with professional "know-how" leads to lessened burden, thus contributing to maintaining well-being of family caregiver population.

Subgroup effects of occupational therapy-based intervention for people with advanced cancer

Background: Many people with advanced cancer have decreased ability to perform activities of daily living (ADL). We recently performed a randomized, controlled trial (RCT) assessing the efficacy of an occupational therapy-based program, the 'Cancer Home-Life Intervention' in people with advanced cancer (N = 242) and found no overall effects on ADL ability. However, heterogeneity of treatment effect may disguise subgroup differences.Objective: To investigate whether subgroups of people with advanced cancer gain positive effects from the 'Cancer Home-Life Intervention' on ADL ability.Material and method: An exploratory subgroup analysis including 191 participants from a RCT. The outcome was ADL motor ability measured by the Assessment of Motor and Process Skills (AMPS). Subgroups were defined by age, gender, years of education, type of primary tumor, functional level, and activity problems.Results: The 'Cancer Home-Life Intervention' had no statistically significant effect in the six subgroups. Modifying effects of age (0.30 [95% CI: -0.05 to 0.64]) and gender (0.23 [95% CI: -0.11 to 0.57]) were not found.Conclusion: There were no subgroup effects of the 'Cancer Home-Life Intervention'on ADL motor ability. Some indications suggest greater effects for those aged below 69 years; however, this result should be interpreted with caution.

Economic evaluations of occupational therapy approaches for people with cognitive and/or functional decline: A systematic review

With the ageing of the world's population comes significant implications for nearly all sectors of society, including health and aged care spending. Health and aged care systems need to respond to the increasing need for services for older people. Occupational therapy is concerned with maintaining a person's functional independence and well-being from preventative and treatment perspectives. The aim of this systematic review was to identify the costs and outcomes of occupational therapy for people with cognitive and/or functional decline. The searches for this review were conducted on 23 September 2016 and updated on 20 April 2017. Full economic evaluation studies, partial economic evaluations, randomised trials reporting estimates of resource use or costs associated with intervention(s) and comparator(s) and studies with pre- and post-intervention cost comparators were included. Thirteen studies met the inclusion criteria. The type and duration of occupational therapy intervention in the included studies varied, ranging from one-off assessments through to systematic multicomponent programmes. Results suggested that structured occupational therapy interventions which comprised of multiple consultations and engaged caregivers delivered better functional and economic outcomes.

Preparing Physical and Occupational Therapists to Be Health Promotion Practitioners: A Call for Action

Experts around the world support the integration of health promotion and wellness (HPW) services into traditional health care services. If successfully executed, the addition of HPW services would reduce rates of death and disability and significantly reduce health care costs. While all health care providers should be engaged in providing HPW services, many believe that physical therapists (PTs) and occupational therapists (OTs) are uniquely positioned to provide these services. However, research suggests that clinicians in both fields may fall short in doing so. Likewise, research indicates that entry-level educational programs inadequately prepare PT and OT students to be HPW practitioners. The overall purpose of this paper is to provide recommendations to educators for preparing PT and OT students and clinicians to better meet the HPW needs of the clients and patients they serve.

Developing the content of a locomotor disability scale for adults in Bangladesh: a qualitative study

Background

Bangladesh has an estimated 17 million adults with disabilities. A significant proportion of them are believed to have locomotor disabilities. There are over 300 non-governmental organizations providing different types of rehabilitation services to them. However, there is no locally developed and validated locomotor disability measurement scale in Bangladesh. The purpose of this study was to develop a locomotor disability scale with disability indicators suitable for adults in Bangladesh.

Methods

Semi-structured interviews were conducted with 25 purposively selected adults with locomotor disabilities to generate scale items. At the second stage, cognitive interviews were conducted with 12 purposively selected adults with locomotor disabilities in order to refine the measurement questions and response categories. Data were analysed using the framework technique- identifying, abstracting, charting and matching themes across the interviews.

Results

For a locomotor disability scale, 70 activities (disability indicators) were identified: 37 mobility activities, 9 activities of daily living, 17 work/productivity activities and 7 leisure activities. Cognitive interviews revealed that when asking the respondents to rate their difficulty in performing the activities, instead of just mentioning the activity name, such as taking a bath or shower, a detailed description of the activity and response options were necessary to ensure consistent interpretation of the disability indicators and response options across all respondents.

Conclusions

Identifying suitable disability indicators was the first step in developing a locomotor disability scale for adults in Bangladesh. Interviewing adults with locomotor disabilities in Bangladesh ensured that the locomotor disability scale is of relevance to them and consequently it has excellent content validity. Further research is needed to evaluate the psychometric properties of this scale.

Community mobility after stroke: a systematic review

Background Stroke is the leading cause of severe disability and many survivors report long-term physical or cognitive impairments that may impact their ability to achieve community mobility (CM).

PURPOSE

To determine the extent to which people with chronic stroke achieve CM compared to age-matched norms or non-neurologically impaired controls. Methods The StrokEDGE outcome measures were searched to identify validated tools that included >25% of items addressing CM. MEDLINE, CINAHL, Google Scholar, PubMed, PEDro and the Cochrane databases were searched from 2001 to 2015 with the identified outcome measures cross-referenced against search terms related to stroke and CM.

INCLUSION CRITERIA

utilized a validated CM outcome measure, chronic (>3 months post) stroke survivors, and randomized controlled trial, observational or cohort study design. One reviewer screened the studies and performed data extraction and three performed quality appraisal. Fourteen studies met all inclusion criteria. Results Stroke survivors have impaired CM as demonstrated by 30-83% of normative or non-stroke subject CM scores. As time post-stroke increased, CM improved only slightly. Factors found to correlate with the CM were age, education, general well-being, emotional state, motor function and coordination, independence in activities of daily living, balance, endurance and driving status. Limitations of this review include a relatively high functioning cohort, no meta-analysis and reliance on outcome measures not specifically designed to measure CM. Conclusion Survivors of stroke may experience a significant decrease in CM compared to people without neurological injury. Rehabilitation addressing motor function, coordination, independence in activities of daily living, balance and endurance may be important for achieving higher levels of CM. Outcome measures directly addressing CM are needed.

A Systematic Review of the Measurement of Function in Late-Life Depression

Recovery of everyday premorbid function is a primary goal in the treatment of depression. Measurement of function is an important part of achieving this goal. A multitude of scales have been used to measure function in depression, reflecting the complex, multifaceted nature of functioning. Currently, however, there are no evidence-based guidelines to assist the researcher or clinician in deciding which instruments are best suited to measure function in late-life depression (LLD). Thus, the aims of this study are to 1) systematically review and identify the instrumental activities of daily living and social functioning assessment instruments used in the LLD literature; 2) identify and appraise the measurement properties of these instruments; and 3) suggest factors for LLD researchers and clinicians to consider when selecting functional assessment instruments and make pertinent recommendations. We performed a systematic review of MEDLINE and CINAHL to identify studies that i) incorporated subjects aged 60 years and older with a depressive disorder, and ii) measured instrumental activities of daily living and/or social functioning. Our search yielded 21 functional assessment instruments. Only two of these instruments, the 36-Item Short Form Survey and the Performance Assessment of Self-Care Skills, have formal validation data in LLD. Four additional instruments, although not formally validated, have relevant data regarding their measurement properties. The primary finding of this study is that very few functional assessment instruments have been validated in LLD, and the available measurement property data are mixed; there is a need for further instrument validation in late-life depression. With this caveat in mind, we provide evidence-based suggestions for researchers and clinicians assessing functioning in LLD patients.

Sleep as an Occupational Need

In the same way the human body requires food, hydration, and oxygen, it also requires sleep. Even among healthy people, the amount and quality of sleep substantially influence health and quality of life because sleep helps regulate physiological functioning. Given the impact of sleep on participation, the American Occupational Therapy Association reclassified sleep from an activity of daily living to an occupational domain. Poor sleep is a frequent medical complaint, especially among populations with neurological impairment. Occupational therapy practitioners should consider routinely screening for factors affecting their clients’ sleep. By addressing such factors, as well as related routines and habits, practitioners can enhance the effectiveness of rehabilitation, promote health and well-being, and increase engagement and life quality. Practitioners should acknowledge the importance of sleep in practice, and the study of sleep should be prioritized by researchers in the field to meet client needs and establish evidence for interventions.

Practices and roles of Irish occupational therapists’ with adults with intellectual disabilities who access supported employment services

Purpose

Work is good for one’s health and well-being. Work for people with disabilities should be encouraged because it is therapeutic and improves participation in the society, leading to better health outcomes. It develops interpersonal relationships and enhances life quality. Work is an aspiration for many people with intellectual disability. Within research literature, there appears to be a lack of research into the experience of occupational therapists in Ireland who refer adults with intellectual disabilities to supported employment services. The purpose of this paper was to explore the experience of Irish occupational therapists who refer adults with intellectual disabilities to supported employment services.

Design/methodology/approach

Semi-structured, in-depth interviews were conducted with four occupational therapists recruited through the Association of Occupational Therapists of Ireland (AOTI). Data were analysed using thematic analysis.

Findings

Themes that emerged were as follows: occupational therapy participants did not directly refer adults to supported employment but received referrals; occupational therapy roles included assessments, task analysis and development of client’s skills are major components of current practice; pragmatics involved factors that facilitate and challenge; and future roles.

Originality/value

This paper contributes to occupational therapy practice knowledge by providing a perspective on supported employment in Ireland. Occupational therapists should continue to work in the area of supported employment to support social inclusion and enable participation. Further research with occupational therapists working in this field is required to inform practice.

Understanding the factors that influence social and community participation as perceived by people with non-traumatic spinal cord injury

Introduction

The number of people with non-traumatic spinal cord injury is rising in developed countries such as Australia and Great Britain. People with non-traumatic spinal cord have different gender, injury and age-related profiles compared to those with traumatically acquired spinal cord injury; therefore, their lived experience is likely to be different. However, the specific issues and challenges that this group faces have not been well investigated.

Method

Semi-structured in-depth interviews were conducted with 17 adults with non-traumatic spinal cord injury. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

Findings

The factors that influenced the social and community participation of people with non-traumatic spinal cord injury were grouped into three broad areas: person factors, factors in the physical and institutional environment, and factors in the social or cultural environment.

Conclusion

The findings from this study inform the understanding of occupational therapists regarding the social and community participation of people with non-traumatic spinal cord injury and how this can be facilitated. Assisting people with non-traumatic spinal cord injury to participate in meaningful social and community-based activities is important to maximise their quality of life.

Social determinants of health, inequality and social inclusion among people with disabilities

OBJECTIVE:

to analyze the socio-familial and community inclusion and social participation of people with disabilities, as well as their inclusion in occupations in daily life.

METHOD:

qualitative study with data collected through open interviews concerning the participants' life histories and systematic observation. The sample was composed of ten individuals with acquired or congenital disabilities living in the region covered by a Family Health Center. The social conception of disability was the theoretical framework used. Data were analyzed according to an interpretative reconstructive approach based on Habermas' Theory of Communicative Action.

RESULTS:

the results show that the socio-familial and community inclusion of the study participants is conditioned to the social determinants of health and present high levels of social inequality expressed by difficult access to PHC and rehabilitation services, work and income, education, culture, transportation and social participation.

CONCLUSION:

there is a need to develop community-centered care programs in cooperation with PHC services aiming to cope with poverty and improve social inclusion.

Assistive technology to enable sleep function in patients with acquired brain injury: Issues and opportunities

Introduction

Sleep disorders in patients with acquired brain injury are highly burdensome and associated with disability. An assistive technology framework emphasises the need to develop and apply a broad range of devices, strategies, and practices to ameliorate disabilities. We aimed to summarise scientific evidence regarding the utility of assistive technology in managing sleep disorders in patients with various causes of acquired brain injury.

Method

We retrieved articles before January 2016, through database searches of Medline, Embase, PsycINFO, CINAHL, and various bibliographies. The person–environment–occupation framework was used to analyse complex data pertaining to technology application and utility.

Results

We found 21 studies that described seven assistive technologies (continuous positive airway pressure, adaptive servo ventilator, nasotracheal suction mechanical ventilation, positioning devices, cognitive behavioural therapy, light therapy, and acupuncture) utilised in patients with acquired brain injury to manage sleep disorders.

Conclusion

Assistive technologies demonstrated effectiveness in alleviating and/or managing sleep disorders after acquired brain injury. Adherence to using the technology is limited by the level of injury-induced cognitive and physical impairment, technological regime, and environmental support. Development of user-friendly sleep-assistive technologies that take into consideration functional limitations and practice guidelines on structural communication between the occupational therapist, patient, and caregiver may facilitate patients’ self-determination in managing sleep disorders.

Qualitative Experience of Sleep in Individuals With Spinal Cord Injury

Poor sleep contributes to adverse health outcomes making it important to understand sleep in medically vulnerable populations, including those with spinal cord injury (SCI). However, little attention has been paid to circumstances specific to SCI that may negatively affect sleep, or to consequences of poor sleep in this population. The objective of this study was to examine the experience of sleep among individuals with SCI. Secondary analysis using thematic coding of qualitative data from an ethnographic study of community-dwelling adults with SCI was conducted. Sleep-related data were found in transcripts for 90% of the sample. Participants described diminished sleep duration and irregular sleep patterns. Several factors contributing to poor sleep were identified, including SCI-related circumstances and sleep environment. Participants also discussed how poor sleep affected occupational engagement. This study highlights the extent of sleep disturbance experienced after SCI and the subsequent impact on occupational performance, and provides direction for clinical practice.

Impact of PANS and PANDAS Exacerbations on Occupational Performance: A Mixed-Methods Study

OBJECTIVE

Pediatric acute-onset neuropsychiatric syndrome (PANS) includes pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and involves sudden-onset neuropsychiatric symptoms, including obsessions, compulsions, sensory difficulties, and dysgraphia after infection or other triggers. Our objective was to identify problems with areas of occupation, body functions, and performance skills during exacerbations.

METHOD

In this online retrospective study, based on the Occupational Therapy Practice Framework: Domain and Process (2nd ed.), we surveyed parents of 111 children with PANS.

RESULTS

Activities of daily living, math, handwriting, extracurricular activities, free play, organized sports, community and family social participation, higher level thinking, attention, memory, sequencing, emotional coping, and energy and drive were commonly affected during exacerbations. During exacerbations, children often required assistance and adaptation to remain functional or were unable to function at a typical level.

CONCLUSION

Children with PANS present with pervasive occupational performance needs during exacerbation. Children and families may benefit from accommodations to maximize function during this turbulent period.

Psychometric Evaluation of the Occupation-Centered Intervention Assessment

A challenge of intervention research is the lack of a means to identify and measure clinical practice from an occupation-centered approach. The objective of this study is to establish basic psychometric properties of the Occupation-Centered Intervention Assessment (OCIA). The study is approached by establishing content validity and utility through expert panel and two focus groups. Interrater reliability (IRR) was determined through standardized video analysis and Krippendorff's alpha. Results from the expert panel and focus groups indicated an overall agreement that the OCIA was able to capture the full range of elements of rehabilitation-focused interventions for older adults (occupational, contextual, and personal relevance) and a good fit with the occupational therapy intervention process model. IRR found adequate level of agreement (α = .76). The OCIA has demonstrated initial basic psychometrics for observation of rehabilitation-focused interventions with older adults.

Using the Newly Developed Floor-Sitting Movement Analysis Proforma to Study the Effect of Age and Activity on Floor-Sitting in Indian Adults

Floor-sitting is culturally relevant to the Indian context. The present study aimed to examine the effect of age and activity on the movement patterns used and time taken to perform floor-sitting in Indian adults. Video-recordings of 30 young (23.30 ± 2.53 years) and 30 older (69.67 ± 6.45 years) adults performing floor-sitting without and with an activity (simulated feeding) were analyzed using the Floor-sitting Movement Analysis Proforma (FMAP) developed for the study. For inter-rater reliability of the FMAP, two raters analyzed the performance of a random sample of 20 participants. An almost perfect inter-rater agreeability (κ ≥ .8) was obtained for the FMAP. Cross-legged sitting was the most preferred (95%) floor-sitting position. Older adults used more number of movement components, asymmetrical patterns, more support, and more time (p < .001) as compared to the young adults. The activity facilitated the use of optimal movement strategies in young and older adults. The activity significantly increased time taken to rise from floor-sitting (p = .004). The study establishes the influence of age and activity on performance of floor-sitting. Older adults use lower developmental movement patterns that may be a "normal" adaptation to age-related sensorimotor changes. Retraining of floor-sitting is a "culturally" desired goal among Indian adults and should involve the practice of age-appropriate movement patterns in the context of meaningful activities.

Antidepressive response of inpatients with major depression to adjuvant occupational therapy: a case-control study

BACKGROUND

Despite marked costs and limited evidence regarding effectiveness, occupational therapy (OT) is widely applied in psychiatric settings and financed by health insurance companies in European countries. This pilot study investigated the antidepressive effects of adjuvant OT for patients with major depression in a 6-week inpatient setting, stratified for females and males.

METHODS

A total of 114 inpatients with major depression were assigned to either a standard OT group (using basic handcraft) or an active control group that played board games (2 h daily, 5 days a week). HAMD-21 scores were assessed as the primary outcome parameter after 3-6 weeks.

RESULTS

The OT intervention was not superior to "board game" (BG) activities in reducing depressive symptoms. However, significant interaction effects were found in favor of the OT group regarding anxiety measures and other variables. Male participants displayed more significant interaction effects than female participants.

CONCLUSIONS

OT as an adjuvant short-term treatment for inpatients with major depression may be more efficacious than game interventions in terms of reducing anxiety and other symptoms, particularly in males. Trial registration The study was registered in the EU Clinical Trials Register as a multicenter trial (EudraCT Number 2009-016463-10; https://www.clinicaltrialsregister.eu/ctr-search/trial/2009-016463-10/DE#A) However, because of the elaborate setting requirements, the original study design with four centers was transformed into a solution with those two centers facilitating the pertinent resources. Furthermore, "mono-therapy with mirtazapine" was changed into "preferably mono-therapy with any antidepressant drug".

Reliability and Validity of the Activity Participation Assessment for School-age Children in Korea

Objective

This pilot study examined the internal consistency, test-retest reliability, construct validity, and discriminant validity of the Activity Participation Assessment (APA) for school-age children in Korea.

Methods

The construct validity of the APA was first established by factor analysis on the response of 134 nondisabled children. Internal consistency was evaluated for each of the factors. A test-retest study was conducted on 22 nondisabled children. Discriminant validity was established by comparing the participation of 56 nondisabled children and 56 children with intellectual disabilities and examining sex differences of 61 boys and 61 girls.

Results

Analysis of the APA revealed five factors, which were labeled as instrumental activities of daily living (IADL), sports and outdoor activities, hobbies and school activities, social activities, and personal care. The factors showed acceptable levels of internal reliability (Cronbach's alpha = .63-.89). The intraclass correlation coefficient (ICC) for the five factors were all in the good range (ICC = .86-.92). We found statistically significant difference between nondisabled children and children with intellectual disabilities in five factors. We also found that girls participated in significantly more IADL, hobbies and school activities, and social activities. However, boys participated in significantly more sports and outdoor activities.

Conclusion

The APA shows good internal reliability, test-retest reliability, discriminant validity, and construct validity. However, evidence of psychometric properties was limited by a small sample size. Psychometric properties such as interrater reliability as well as concurrent validity and construct validity need to be tested using a larger sample size with representative demographics.