American Journal of Occupational Therapy

Systematic reviews of literature relevant to individuals with work-related injuries and illnesses are important to the practice of occupational therapy. This article describes the four questions that served as the focus for the systematic reviews of the effectiveness of occupational therapy interventions for individuals with work-related injuries and illnesses of the low back; hand, wrist, and forearm; elbow; and shoulder. The article includes the background for the reviews; the process followed for each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. The final number of articles included in each systematic review; a summary of the results; the strengths and limitations of the findings; and the implications for practice, education, and research are presented.

The objectives of this systematic review were (1) to identify, evaluate, and synthesize the research literature of relevance to occupational therapy regarding interventions for work-related shoulder conditions and (2) to interpret and apply the research literature to occupational therapy. Twenty-two studies were reviewed for this study—16 of Level I evidence, 2 of Level II evidence, and 4 of Level III evidence. In this systematic review, limited evidence from Level I studies was found to support exercise for shoulder pain; manual therapy and laser for adhesive capsulitis; conservative management of shoulder instability; early intervention without immobilization for specific, nondisplaced proximal humerus fractures; and exercise, joint mobilizations, and laser for patients with shoulder impingement. Further prospective studies are necessary for the delineation of specific surgical and therapeutic variables that facilitate positive outcomes in the treatment of patients with shoulder conditions.

This systematic review of literature examines and synthesizes research findings related to interventions for people with work-related elbow injuries, particularly epicondylitis. It was carried out as part of the Evidence-Based Literature Review Project of the American Occupational Therapy Association. The 11 articles included in this review suggest multiple approaches to intervention but do not provide sufficient evidence to determine which methods or approaches are best practice. Research has provided little evidence to support the use of commonly prescribed interventions for epicondylitis, the most frequently reported work-related elbow injury. Collectively, the evidence to support the use of splinting, exercise, or physical agent modalities is weak and provides little guidance for approaching management of elbow injuries. The implications for education and research are discussed, as is the application of the evidence to clinical practice in occupational therapy.

A systematic review of the literature related to effective occupational therapy interventions in rehabilitation of individuals with work-related forearm, wrist, and hand injuries and illnesses was conducted as part of the Evidence-Based Literature Review Project of the American Occupational Therapy Association. This review provides a comprehensive overview and analysis of 36 studies that addressed many of the interventions commonly used in hand rehabilitation. Findings reveal that the use of occupation-based activities has reasonable yet limited evidence to support its effectiveness. This review supports the premise that many client factors can be positively affected through the use of several commonly used occupational therapy–related modalities and methods. The implications for occupational therapy practice, research, and education and limitations of reviewed studies are also discussed.

A systematic review of the literature related to effective occupational therapy interventions in rehabilitation of individuals with work-related low back injuries and illnesses was carried out as part of the Evidence-Based Literature Review Project of the American Occupational Therapy Association. This review evaluated research on a broad range of occupational therapy–related intervention procedures and approaches. Findings from the review indicate that the evidence is insufficient to support or refute the effectiveness of exercise therapy and other conservative treatments for subacute and chronic low back injuries. The research reviewed strongly suggests that for interventions to be effective, occupational therapy practitioners should use a holistic, client-centered approach. The research supports the need for occupational therapy practitioners to consider multiple strategies for addressing clients’ needs. Specifically, interventions for individuals with low back injuries and illnesses should incorporate a biopsychosocial, client-centered approach that includes actively involving the client in the rehabilitation process at the beginning of the intervention process and addressing the client’s psychosocial needs in addition to his or her physical impairments. The implications for occupational therapy practice, research, and education are also discussed.

PURPOSE. We generated a clinically useful data collection form for the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. This data collection form is designed to aid in measuring change and goal setting.

METHOD. Rasch analysis was used to generate three data collection forms for constructs on the DASH (gross motor, fine motor, and symptoms; N = 960). A form was completed to represent the findings from 1 study participant. Admission and discharge data were illustrated for one of the three sections (gross motor activity). Possible goals were indicated on the admission form. The discharge form illustrates whether these goals have been achieved.

RESULTS. Figures illustrate the utility of the forms in observing functional change from admission to discharge and how the forms aid in goal setting.

CONCLUSION. Use of the data collection form has many positive implications. This type of form could aid in goal setting and treatment planning.

Despite the need for occupational therapy to emphasize client-specific occupational performance, primary emphasis in stroke rehabilitation continues to be on the remediation of client factors and self-care. Such practice leaves many survivors of stroke with continuing performance deficits. Two case studies demonstrate a novel, alternative approach. The Cognitive Orientation to Daily Occupational Performance (CO–OP) treatment is a performance-based, problem-solving approach to developing functional skills that are client centered. CO–OP was used to guide treatment with 2 older women. The findings suggest that the approach has the potential to successfully help clients with stroke achieve their everyday occupational goals and support continued research in this area. This work will lead to a pilot randomized controlled trial.

The purpose of this translational research article is to illustrate how general practice occupational therapists have the skills and knowledge to address driving as a valued occupation using an algorithm based on the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; American Occupational Therapy Association, 2008b). Evidence to support the model is offered by a research study. Participants were compared on their performance of complex instrumental activities of daily living (IADLs) and a behind-the-wheel driving assessment. A significant relationship was found between the process skills from the performance assessment and whether the driver passed, failed, or needed restrictions as indicated by the behind-the-wheel assessment. The evidence suggests that occupational therapists using observational performance evaluation of IADLs can assist in determining who might be an at-risk driver. The algorithm addresses how driver rehabilitation specialists can be used most effectively and efficiently with general practice occupational therapy practitioners meeting the needs of senior drivers.

The purpose of this pilot study was to establish a model for randomized controlled trial research, identify appropriate outcome measures, and address the effectiveness of sensory integration (SI) interventions in children with autism spectrum disorders (ASD). Children ages 6–12 with ASD were randomly assigned to a fine motor or SI treatment group. Pretests and posttests measured social responsiveness, sensory processing, functional motor skills, and social–emotional factors. Results identified significant positive changes in Goal Attainment Scaling scores for both groups; more significant changes occurred in the SI group, and a significant decrease in autistic mannerisms occurred in the SI group. No other results were significant. The study discusses considerations for designing future outcome studies for children with ASD.

We identified factors associated with occupational therapists’ involvement as children receiving early intervention services transition into preschool. A survey was sent to members of the American Occupational Therapy Association’s School System Special Interest Section. The highest ranked factor for respondents in early intervention was understanding their role (mean [M]= 4.96, standard deviation [SD] = 1.26, n = 78) and for respondents in preschool programs it was having preschool staff value their participation (M = 4.84, SD = 1.46, n = 248). Preschool occupational therapists’ relationship with early intervention providers, employer-based supports, and knowledge of the transition process were significantly associated with their involvement in two transition planning areas: collaboration with early intervention programs (p < .001) and family support (p < .001). Findings suggest that practices that enhance relationships among programs influence occupational therapist involvement. Implications for formal training to support involvement in the transition process are discussed.

OBJECTIVE. We pilot tested the efficacy of computer-based training implementing rhythm and timing in chronic, severe, stroke-induced hemiparesis.

METHOD. Two chronic stroke patients were administered the upper-extremity section of the Fugl-Meyer Impairment Scale (FM), the Arm Motor Ability Test (AMAT), Stroke Impact Scale (SIS), and Canadian Occupational Performance Measure (COPM). We then administered the computer-based intervention for 60 min, 3 days/wk for 4 wk. One week after intervention, we administered the FM, AMAT, COPM, and SIS.

RESULTS. After intervention, participants exhibited reduced arm impairment (indicated by FM scores of +2.0 and +4.0) and increases in average functional ability (+0.85 and +1.1 points on the AMAT), perceived quality of life (+2.0 and +32.0 points on the SIS), and perception of overall recovery (+10.0 points for each participant on the SIS).

CONCLUSION. This study provides preliminary evidence suggesting efficacy of computer-based rhythm and timing in chronic stroke.

We examined caregiver awareness of the American Academy of Pediatrics’ prone play recommendation, determined the primary sources of the recommendation, and examined why some infants are not provided “tummy time.” Of caregivers, 25% were not aware of prone play recommendations, and one-fourth of that group was not aware of potential complications from limited tummy time. The primary sources of prone play information and potential complications were printed materials, then pediatricians. Of infants, 53% received ≤30 min; 35% were intolerant of the prone position. This study indicates that many caregivers are not aware of tummy time and complications that can occur if it is not provided. Health care professionals, including therapists, must educate parents on the importance of prone play and provide information on how to increase infant tolerance for prone play time.

OBJECTIVE. We examined the relationship between pain perception, as expressed by pain catastrophizing level, and sensory processing patterns among typical adults.

METHOD. Two hundred ninety healthy adults participated in this study: 138 men and 152 women. Their ages ranged from 18 to 50 (mean age = 30.2 ± 6.8). All participants completed the Adolescent/Adult Sensory Profile and the Pain Catastrophizing Scale (PCS).

RESULTS. PCS scores significantly correlated with Low Registration, Sensory Sensitivity, and Sensation Avoiding. Women had higher sensory sensitivity and a higher pain catastrophizing level than did men.

CONCLUSION. Sensory processing patterns may be related to individual pain perception, as expressed in pain catastrophizing level. Intervention programs should take these factors into account to be more focused on the specific needs of each client, facilitate his or her optimal engagement in daily living activities, and elevate well-being.

OBJECTIVE. We developed the Modified Occupational Questionnaire (MOQ), a simple, quantitative measure of meaningful time use.

METHOD. The MOQ, a time diary based on the Occupational Questionnaire, was piloted with a group of occupational therapy students and revised before use in a larger investigation involving young unemployed Australians (N = 228). External validity was examined by comparing MOQ time-use data with data from the 2006 Australian Time Use Survey. Internal validity was examined through Rasch analysis procedures.

RESULTS. The MOQ demonstrated very good external validity (correlations >.85); acceptable rating scale, item function, and person performance validity; very good item and person reliability indexes (1.00 and 0.93, respectively); and a good person separation index (3.52).

CONCLUSION. The MOQ is a simple and valid measure of the basic elements of meaningful time use. Future research is required to further develop the MOQ, particularly in populations other than people who are unemployed.