American Journal of Occupational Therapy

PURPOSE. We explored the occupational performance and home safety perspectives of older adults with vision loss. Our study focused on the person–environment interaction to ascertain whether participants’ concerns are addressed by three commonly used home safety assessments.

METHOD. Twenty-two older adults with vision loss participated in face-to-face interviews regarding their perspectives on home safety. We compared categories generated from a content analysis of the data with the contents of three standardized home safety assessments.

RESULTS. Five categories of home safety emerged from the analysis: (1) lighting, (2) contrast, (3) visual distractions, (4) glare, and (5) compensation strategies. Comparisons of content in the three home safety assessments with emerged categories revealed that study participants had specific concerns about home safety that were not thoroughly addressed in the selected assessments.

CONCLUSION. The findings provide preliminary content areas that should be included in the development of a home assessment specific to the low vision population.

OBJECTIVE. This study evaluated the validity of using Assessment of Motor and Process Skills (AMPS) measures as evidence of the need for assistance in the community.

METHOD. In a retrospective analysis of existing data (N = 64,466), receiver operating characteristic (ROC) curves were generated, and a split-sample method was used to validate the predictions.

RESULTS. When identifying people who need assistance versus those who do not need assistance in the community, activity of daily living (ADL) motor and ADL process measures have fair and good discriminating value, respectively (areas under the ROC curves were .78 and .84). Evidence supports placing ADL motor and ADL process independence cutoff measures at 1.50 logits (sensitivity = .67, specificity = .72) and 1.00 logit (sensitivity = .81, specificity = .70), respectively. Accuracy was highest when matched motor and process decisions occurred (sensitivity = .85, specificity = .83).

CONCLUSION. Evidence supports using ADL ability measures from the AMPS to provide evidence of a client’s need for assistance in the community.

The Driving to Learn project explored ways to help people with profound cognitive disabilities practice operating a joystick-operated powered wheelchair. The project used a grounded theory approach with constant comparative analysis and was carried out over 12 yr. The participants were 45 children and adults with profound cognitive disabilities. Reference groups included 17 typically developing infants and 64 participants with lesser degrees of cognitive disability. The data sources included video recordings, field notes, open interviews, and a rich mixture of literature. The findings that emerged yielded strategies for facilitating achievements, an 8-phase learning process, an assessment tool, and a grounded theory of deplateauing explaining the properties necessary for participants to exceed expected limitations and plateaus. Eight participants with profound cognitive disabilities reached goal-directed driving or higher. Participants were empowered by attaining increased control over tool use, improving their autonomy and quality of life.

OBJECTIVE. We examined the correlations between quality of life and three adaptation factors—adjusted self-concept, social support, and accessibility—in people with multiple sclerosis (MS).

METHOD. A convenience sample of 68 participants completed the Leeds Multiple Sclerosis Quality of Life scale (LMSQoL) and a questionnaire assessing the three adaptation factors.

RESULTS. We found significant moderate correlations between LMSQoL scores and adjusted self-concept (r = .56, p < .0001) and LMSQoL scores and social support (r = .52, p < .0001); a significant low correlation was found between LMSQoL and accessibility (r = .36, p = .003).

DISCUSSION. Adjusted self-concept, social support, and accessibility were found to be critical in participants’ psychosocial adaptation to the course of MS. Occupational therapy intervention should address these adaptation factors to help clients cope with MS and promote quality of life.

We developed and piloted a program for first-grade students to promote development of legible handwriting and writing fluency. The Write Start program uses a coteaching model in which occupational therapists and teachers collaborate to develop and implement a handwriting–writing program. The small-group format with embedded individualized supports allows the therapist to guide and monitor student performance and provide immediate feedback. The 12-wk program was implemented with 1 class of 19 students. We administered the Evaluation of Children’s Handwriting Test, Minnesota Handwriting Assessment, and Woodcock–Johnson Fluency and Writing Samples test at baseline, immediately after the Write Start program, and at the end of the school year. Students made large, significant gains in handwriting legibility and speed and in writing fluency that were maintained at 6-mo follow-up. The Write Start program appears to promote handwriting and writing skills in first-grade students and is ready for further study in controlled trials.

Parents of children with autism report high rates of stress. Parental differences in stress are inconsistent, with most research indicating that mothers report higher levels of stress than fathers. We explored parental differences before and after an in-home training program. Fathers were taught an intervention designed to improve their child’s social reciprocity and communication; they then trained mothers. Stress was assessed with the Parenting Stress Index–Short Form, and family dynamics was assessed with the Family Adaptability and Cohesion Evaluation Scales II. Both mothers and fathers reported high preintervention levels of stress. After intervention, fathers’ stress was reduced, but not significantly, possibly because of the variability in fathers’ scores; mothers’ stress scores were significantly reduced. Parenting styles were significantly different before and after intervention. Interdisciplinary teams, including occupational therapists, nurses, and special educators, can work together to have a positive impact on the lives of families of children with autism.

OBJECTIVE. In this pilot study, we determined the effectiveness of a weighted vest on attention to task for second-grade general education students with difficulty attending.

METHOD. We used an intervention and a control group and an ABA design to compare participants’ percentage of time on task with and without a vest. Ten participants from nine elementary schools in a suburban Texas school district were randomly assigned to an intervention or a control group. Control group participants wore a nonweighted vest. Participants, classroom teachers, and research assistants who coded the data were blind as to the group to which the participants were assigned.

RESULTS. A repeated measures analysis of variance indicated no significant differences between groups or between baseline, intervention, and withdrawal conditions.

CONCLUSION. Our results indicated that the weighted vests were not effective in increasing time on task. These results should be generalized cautiously owing to the small sample size and participant selection process.

We examined the relationship between postural control and fine motor skills of preterm infants at 6 and 12 mo adjusted age. The Alberta Infant Motor Scale was used to measure postural control, and the Peabody Developmental Motor Scales II was used to measure fine motor skills. The data analyzed were taken from 105 medical records from a preterm infant follow-up clinic at an urban academic medical center in south Taiwan. Using multiple regression analyses, we found that the development of postural control is related to the development of fine motor skills, especially in the group of preterm infants with delayed postural control. This finding supports the theoretical assumption of proximal–distal development used by many occupational therapists to guide intervention. Further research is suggested to corroborate findings.

OBJECTIVE. We attempted to determine whether multimedia fall prevention education using different instructional strategies increases older adults’ knowledge of fall threats and their fall prevention behaviors.

METHOD. Fifty-three community-dwelling older adults were randomized to two educational groups or a control group. Multimedia-based educational interventions to increase fall threats knowledge and encourage fall prevention behaviors had two tailoring strategies: (1) improve content realism for individual learners (authenticity group) and (2) highlight program goals and benefits while using participants’ content selections (motivation group). Knowledge was measured at baseline and 1-mo follow-up. Participants recorded prevention behaviors for 1 mo.

RESULTS. Intervention group participants showed greater knowledge gains and posttest knowledge than did control group participants. The motivation group engaged in more prevention behaviors over 1 mo than did the other groups.

CONCLUSION. Tailoring fall prevention education by addressing authenticity and motivation successfully improved fall threats knowledge. Combining motivational strategies with multimedia education increased the effectiveness of the intervention in encouraging fall prevention behaviors.

The manualization of a complex occupational therapy intervention is a crucial step in ensuring treatment fidelity for both clinical application and research purposes. Toward the latter end, intervention manuals are essential for ensuring trustworthiness and replicability of randomized controlled trials that aim to provide evidence of the effectiveness of occupational therapy. In this article, we review the literature on the process of intervention manualization. We then illustrate the prescribed steps through our experience in implementing the University of Southern California/Rancho Los Amigos National Rehabilitation Center’s collaborative Pressure Ulcer Prevention Project. In this research program, qualitative research provided the initial foundation for manualization of a multifaceted occupational therapy intervention designed to reduce the incidence of medically serious pressure ulcers in adults with spinal cord injury.

OBJECTIVE. This qualitative focus group study investigated the strategies to prevent or reduce practice errors used by occupational therapists who practice in physical rehabilitation and geriatrics.

METHOD. A total of 34 occupational therapists from four geographic regions across the United States participated in four focus groups. Participants worked in the areas of physical rehabilitation or geriatrics and had a minimum of 1 year of practice. Participants responded to open-ended, guiding questions. Data collected from the focus groups were analyzed qualitatively for themes.

RESULTS. Analysis of the collected data yielded four themes related to specific strategies occupational therapists use to prevent or reduce practice errors: (1) strengthen orientation and mentoring for new therapists, (2) ensure competency through performance competency checks, (3) enhance existing or establish new safety policies and procedures, and (4) advocate for the profession and for systemic change.

CONCLUSION. Findings of the study suggest that occupational therapists implement various discrete strategies to prevent or reduce practice errors and improve client safety. Occupational therapy practice and professional training must emphasize the inevitability of practice errors; the importance of orientation and training, including assertiveness training; and the inclusion of performance-based competency checks.

Recovery from serious mental illness refers to the attainment of a meaningful, productive, and satisfying life, regardless of the presence or absence of reoccurring symptoms. A lack of psychometrically sound instruments has thwarted attempts to measure recovery. With the goal of addressing this need, we administered the Recovery Assessment Scale (RAS) to 92 people with serious mental illness attending a Clubhouse program. Clubhouses are community-based psychosocial rehabilitation programs for people living with mental illness. Rasch analysis enabled close examination of the RAS’s internal validity and reliability. Through iterative analyses, we made enhancements to the instrument where possible. The preponderance of evidence suggests that the modified RAS forms a unidimensional construct; however, the instrument remains far from a gold standard. Occupational therapy is well suited to take leadership in further development of this instrument.

We compared the critical reasoning (CR) of four classes of students entering a bachelor of occupational therapy program (n = 88) with the CR of five classes of students entering an entry-level master of occupational therapy program (n = 126) using the Watson–Glaser Critical Thinking Appraisal (WGCTA) and controlling for grade point average and reading comprehension as measured by the Nelson–Denny Reading Test. A multivariate analysis of covariance revealed a small but statistically significant difference between the groups’ CR scores. The univariate tests indicated that the groups differed with respect to their scores on one WGCTA subscale, Recognition of Assumptions; contrary to expectations, the bachelor’s students scored higher than the master’s students, although the effect size indicated small differences between the groups. Possible explanations for the findings and implications for occupational therapy education are discussed.

Almost half of falls occur outdoors; yet, the emphasis in fall prevention has been on intrinsic factors and the indoor environment. In this article we argue that the neighborhood environment and its impact on falls warrants further attention. Occupational therapy is best suited to address these issues in collaboration with urban planners and public health professionals. Both practice and policy changes are suggested to meet the health and wellness needs of community-dwelling older adults going forward.