American Journal of Occupational Therapy

In this systematic review, we investigated research literature evaluating the effectiveness of occupational therapy interventions focusing on participation and performance in occupations related to paid and unpaid employment and education for people with serious mental illness. The review included occupation- and activity-based interventions and interventions addressing performance skills, aspects of the environment, activity demands, and client factors. The results indicate that strong evidence exists for the effectiveness of supported employment using individual placement and support to result in competitive employment. These outcomes are stronger when combined with cognitive or social skills training. Supported education programs emphasizing goal setting, skill development, and cognitive training result in increased participation in educational pursuits. The evidence for instrumental activities of daily living interventions that targeted specific homemaking occupations and supported parenting was limited but positive. Environmental cognitive supports, such as signs, and other compensatory strategies are useful in managing maladaptive behavior.

This systematic review investigated research literature evaluating the effectiveness of occupational therapy interventions focusing on recovery in the areas of community integration and normative life roles for people with serious mental illness. The review included occupation- and activity-based interventions and interventions addressing performance skills and performance patterns, aspects of context and environment, activity demands, and client factors. The results indicated that the evidence of the effectiveness of social skills training is moderate to strong. The evidence for the effectiveness of life skills and instrumental activities of daily living (IADLs) training to improve performance is moderate, as is the evidence for neurocognitive training paired with skills training in the areas of work, social participation, and IADLs. The evidence for client-centered intervention and increased intensity and duration of treatment is limited but positive, and the evidence that providing intervention in the natural context is more beneficial than in the clinic setting is inconclusive.

Activity-based group work is widely used by occupational therapists in mental health settings (Lloyd, King, & Bassett, 2002), but the evidence to support this intervention is unclear. We therefore conducted a systematic review focused on the question, “Is activity-based group work effective in helping people with severe and enduring mental illness in community settings improve their functional ability and/or reduce their mental health symptoms?” We used a wide-ranging search strategy, including electronic searching, hand searching, citation searching, and use of gray literature, and identified 136 potentially relevant papers. After assessment of relevance and quality, only 3 articles met the minimum criteria. Heterogeneity and flaws in quality meant it was not possible to make specific inferences for practice from the studies. Large-scale rigorous research, in the form of randomized controlled trials, is urgently needed to identify whether activity-based group work is effective.

OBJECTIVE. We assessed the efficacy and clinical utility of a new occupational time-use intervention, Action Over Inertia, designed to improve occupational balance and engagement among community-dwelling people with serious mental illness.

METHOD. Using a randomized controlled design, we assigned 24 participants to an intervention group or standard care group. Participants were community-dwelling people with serious mental illness receiving assertive community treatment services. Data on time use, occupational balance, and engagement were collected and compared at baseline and 12-wk posttest.

RESULTS. Eighteen participants completed the pilot study. Treatment group participants increased their occupational balance by spending an average of 47 min more per day in activity than the control group (p = .05). Differences in occupational engagement were not shown, but evidence of clinical utility was found.

CONCLUSION. This pilot study of Action Over Inertia has shown evidence of efficacy and clinical utility.

OBJECTIVE. We investigated the effectiveness of a life skills intervention for people with mental illness who have been homeless.

METHOD. In this longitudinal outcomes study, we used Situated Learning Theory (Lave & Wenger, 1991) to provide group and individual sessions to 38 participants from two housing programs after completing baseline Allen Cognitive Level Screen–2000 (ACLS–2000; Allen Conferences, 2000) and Practical Skills Tests (PSTs). Data were analyzed using linear mixed-effects regression models.

RESULTS. The PST scores of participants with higher ACLS–2000 scores significantly increased over time (food management, p = .021; money management, p = .039; safe community participation, p = .02). Participants with lower ACLS–2000 scores demonstrated an even greater change over time.

CONCLUSION. Most participants, including those with lower ACLS–2000 scores, improved and retained life skills knowledge over time, challenging the premise that people with mental illness should be excluded from mixed-level group interventions.

OBJECTIVE. The effectiveness of Occupational Goal Intervention (OGI) in clients with schizophrenia was compared with that of the Frontal Executive Program and a control group.

METHOD. We used a quasi-experimental design with 18 adult participants ages 20–38 who were randomly assigned to three groups. Testing was performed before treatment, after treatment, and at 6-mo follow-up (Time 2). Instruments assessed executive functions (EFs) and activity and participation. Participants received 18 treatment sessions over a period of 6–8 wk.

RESULTS. We found no significant differences among the groups on pretest–posttest change; however, we did find significant differences within groups before and after intervention and moderate to high effect sizes. The OGI group showed relative improvement on all measures of EF and activity and participation. Most participants’ achievements were maintained at Time 2.

CONCLUSIONS. Results provide initial support for the OGI’s effectiveness for clients with schizophrenia. Further studies are needed to verify these initial findings.

PURPOSE. We tested the effectiveness of an educational intervention in DVD format aimed at strengthening the mental health practices of occupational therapists working with older adults.

METHOD. The DVD intervention was tested in a pretest–posttest design. Occupational therapists (n = 30) completed a brief knowledge and attitude questionnaire; a chart review (n = 383) of therapists’ (n = 20) patients at 3 mo before and 3 mo after DVD training was also conducted.

RESULTS. Questionnaire data showed that the percentage of therapists with correct answers increased 20%–30% for 5 of the 11 knowledge items. Chart review data showed therapists spoke more often with their older patients about mood, depression, and cognitive impairment; screened more often for depression and cognitive impairment; and reported findings more often to the treatment team after training.

CONCLUSION. Educational interventions can significantly improve therapists’ mental health practice with older adults.

OBJECTIVE. We investigated participation levels and relationships among cognition, depression, and participation for people with severe congestive heart failure (CHF).

METHOD. People with severe CHF (New York Heart Association Class III or IV) awaiting heart transplantation (N = 27) completed standardized tests of cognition and self-report measures of executive dysfunction, depressive symptoms, and participation.

RESULTS. Possible depression (64%) and cognitive impairment (15%–59%) were prevalent. Participants reported significant reductions in participation across all activity domains since CHF diagnosis (ps < .001). Worse executive dysfunction and depressive symptoms were associated with reduced participation and together accounted for 35%–46% of the variance in participation (ps < .01).

CONCLUSION. Participation restrictions associated with CHF are not limited to physically demanding activities and are significantly associated with executive dysfunction and depression. Cardiac rehabilitation should address cognitive and psychological functioning in the context of all life situations instead of focusing solely on physical function and disability.

OBJECTIVE. We retrospectively assessed the effect of social-, cognitive-, and task-oriented functioning levels at hospital discharge on the readmission rate of patients with schizophrenia.

METHOD. We assessed the functional capability of 71 inpatients (37 men and 34 women), mean age 41.3 (standard deviation = 11.9 yr), who underwent daily occupational therapy interventions, at admission and at discharge using a comprehensive function score. We examined readmission rates up to 6.8 yr after discharge.

RESULTS. Function scores improved significantly during the hospital stay (p < .001). Patients with a higher comprehensive function score (75th percentile) at the end of the index admission had a significantly lower readmission rate (p < .05). A higher comprehensive function score (75th percentile) at discharge was a better predictor for readmission than the Brief Psychiatric Rating Score (25th percentile).

CONCLUSION. These findings demonstrate the predictive value of occupational therapy functional monitoring at discharge for risk of readmission and the importance of cognitive/functional interventions for long-lasting remission.

OBJECTIVE. We explored the relationships between sensory modulation and health-related quality of life (HRQOL), social supports, and mental health symptoms of anxiety and depression.

METHOD. Twenty-eight adult volunteers ages 18–60 participated in the study. Fourteen adults were sensory overresponsive (SOR), and 14 adults in a matched comparative group were not sensory overresponsive (NSOR). All participants were tested using self-administered measures of sensory processing.

RESULTS. Significant differences were found between SOR and NSOR groups on symptoms of anxiety, depression, and 4 of 8 indicators of HRQOL.

CONCLUSION. Several analyses exploring the relationships among the variables tested suggest that sensory response style, whether comparing SOR and NSOR groups or exploring the correlation of the response quadrants of the Adolescent/Adult Sensory Profile, appears significantly and differentially related to symptoms of affective mental health and quality-of-life indicators, including social participation.

We explored personal factors that can predict health-related lifestyles of community-dwelling older adults. A convenience sample of 253 older adults was recruited to complete the Health Enhancement Lifestyle Profile (HELP), a comprehensive measure of health-promoting behaviors. Data were analyzed through univariate correlational/comparative statistics followed by stepwise multiple regression analysis to determine significant predictor variables for different aspects of health-related lifestyle. Personal health conditions, including the number of chronic diseases or impairments and self-rated health, were two strong predictors for the HELP (R ² = .571, p < .0001). Demographic characteristics, including age, gender, race, education, and employment status, also demonstrated varied degrees of capability for predicting the different HELP scales (e.g., Exercise, Diet, Leisure). When developing individualized plans for older adults in community settings, occupational therapists should consider the clients’ strengths and vulnerabilities potentially derived from personal health factors and demographic attributes to yield more effective lifestyle interventions.

The history of articles in the American Journal of Occupational Therapy and its predecessors reflects trends and changes in professional terminology and the thoughts underlying that terminology. In this study, we investigate use of occupation, activity, and related terms across 9 decades of occupational therapy literature from the 1920s to the 2000s. The literature for 3 years of each of the 9 decades was scanned electronically. A random numbers table was used to equalize the number of words across decades, and a computer search function was used to determine each term’s frequency of use for each decade. Results indicated that the term occupation was widely used in the 1920s but then declined until the 1980s. With a rapid increase in use in the 2000s, the term occupation actually appeared more often than it did in the 1920s. The term activity appeared infrequently in the 1920s but gained popularity from the 1930s to the 1960s. From the 1970s to the 1990s, the use of both terms was quite low. This study shows that basic occupational therapy terminology has fluctuated dramatically over time. Given the essential link between terminology and theory, these changes arguably reflect authors’ and editors’ changing viewpoints on the profession’s fundamental nature.

Journal quality metrics (also referred to as bibliometrics), such as impact factors, are increasingly being used as a measure of researchers’ and educators’ success and prestige. Occupational therapists who submit articles to peer-reviewed journals may face a professional and research dilemma: Do they submit their articles to journals that largely have a professional audience and potentially do not have an impact factor, or do they opt not to publish their research material in occupational therapy–oriented journals? Occupational therapy authors can consider other journal quality metric alternatives, in addition to the impact factor option, including the Eigenfactor Score, Article Influence Score, h-index, SCImago Journal Rank (SJR), Source Normalised Impact per Paper (SNIP), and discipline-specific generated journal quality measures. These other journal quality metrics can be important reference points for occupational therapists who publish and may encourage authors to publish in journals relevant to the discipline. This process, in turn, will build the occupational therapy body of knowledge as well as provide an essential, growing reference source for evidence-based practice.

We conducted a systematic review focusing on articles in the occupational therapy practice category of Children and Youth published in the American Journal of Occupational Therapy over the 2-yr period of 2009–2010. We used the frameworks of the International Classification of Functioning, Disability and Health (ICF) and Positive Youth Development (PYD) to explore occupational therapy research progress toward the goals of the Centennial Vision. We organized 46 research articles by research type and classified them within these two frameworks. Most reviewed published research investigated variables representing constructs falling within the ICF domains of Body Functioning and Activity. The effect of occupational therapy interventions on PYD resided primarily in building competence. To meet the tenets of the Centennial Vision, occupational therapists must document changes in children’s engagement in everyday life situations and build the evidence of occupational therapist’s efficacy in facilitating participation.

OBJECTIVES. Our objectives were (1) to compare the differential effects of cultural and sociodemographic variables on the cognitive performance of Israeli and Palestinian children, (2) to examine validity of the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) for kindergarten children, and (3) to determine the feasibility of using the LOTCA as a screening tool for assessing Palestinian children’s cognitive abilities.

METHOD. Participants were 101 Jewish Israeli and 125 Muslim Palestinian children, ranging in grade from kindergarten to second grade.

RESULTS. Israeli children achieved significantly higher scores than the Palestinian children on most LOTCA domains. We obtained significant Grade × Cultural Group interaction effects (F[10, 364] = 1.73, p < .001, effect size [ES] − η² = .045) and also found a significant Cultural Group × Mother's Education interaction (F[5, 184] = 2.49, p < .05, ES − η² = .064).

CONCLUSION. Cultural and sociodemographic variables appear to affect cognitive performance. The LOTCA revealed cognitive differences between the cultural groups and school grades and may thus constitute an appropriate evaluation tool focusing on children’s school grade promotion.