American Journal of Occupational Therapy

Systematic reviews of the literature relevant to community-dwelling older adults are important to the practice of occupational therapy. We describe the four questions that served as the focus for the systematic reviews of the effectiveness of occupational therapy interventions for older adults living in the community. This 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 implications for practice, education, and research are presented.

We describe the results of a systematic review of the literature on occupation- and activity-based health management and maintenance interventions for productive aging. We found moderate to strong evidence that client-centered occupational therapy improved physical functioning and occupational performance related to health management in community-dwelling older adults, as well as in adults with osteoarthritis and macular degeneration. We found moderate evidence that health education programs reduce pain and increase physical activity and that individualized health action plans improve activities of daily living function and participation in physical activities. The evidence that self-management programs result in a decrease in pain and disability and that incorporating cognitive–behavioral principles into physical activity improves long-term participation in exercise was also moderate. Although the evidence for skill-specific training in isolation is limited, effectiveness increases when skill-specific training is combined with health management programs. The implications for practice, education, and research are discussed.

This systematic review explored the impact of fall prevention programs and home modifications on falls and the performance of community-dwelling older adults. It was conducted as part of the American Occupational Therapy Association’s Evidence-Based Practice Project. Thirty-three articles were analyzed and synthesized. The strongest results were found for multifactorial programs that included home evaluations and home modifications, physical activity or exercise, education, vision and medication checks, or assistive technology to prevent falls. Positive outcomes included a decreased rate of functional decline, a decrease in fear of falling, and an increase in physical factors such as balance and strength. The strength of the evidence for physical activity and home modification programs provided individually was moderate. Implications for practice, education, and research are also discussed.

This systematic review examines the effectiveness of occupation- and activity-based interventions on community-dwelling older adults’ performance of instrumental activities of daily living (IADLs). It was conducted as part of the American Occupational Therapy Association’s Evidence-Based Practice Project. Forty studies met the inclusion criteria and were critically appraised and synthesized. Within occupation-based and client-centered interventions, the evidence that multicomponent interventions improve and maintain IADL performance in community-dwelling older adults is strong. The results also indicate that client-centered, occupation-based interventions can be effective in improving and maintaining IADL performance. The evidence is moderate for functional task exercise programs and limited for simulated IADL interventions to improve IADL performance. In the area of performance skills, the evidence related to physical activity and cognitive skills training is mixed, and the evidence that vision rehabilitation interventions improve IADL performance in older adults with low vision is moderate. Implications for practice, education, and research are also discussed.

We conducted this systematic review, one of four related to productive aging, to explore the existing evidence for the health benefits of engagement in occupations and activities among older adults. The review incorporates the breadth of areas of occupation in which older adults engage and the range of health benefits derived from that engagement. The results of this review demonstrate the multidisciplinary appreciation for occupational engagement and associated well-being and elucidate the health effects of engagement in a wide variety of occupations and activities. Additionally, the results of this systematic review support occupational therapy’s historical ideologies and core philosophies linking occupational engagement to improved health and well-being. The findings suggest an increasing role for occupational therapy service delivery in community-based health promotion and prevention efforts to meet the everyday activity and health needs of the growing older adult population.

OBJECTIVE. We studied the internal consistency reliability and construct validity of the new Dynamic Lowenstein Occupational Therapy Cognitive Assessment–Geriatric Version (DLOTCA–G), a dynamic version of the Lowenstein Occupational Therapy Cognitive Assessment–Geriatric Version (LOTCA–G), and examined the properties of the mediation system.

METHOD. Participants included 61 clients hospitalized after stroke in three rehabilitation centers (mean age = 77.6 yr, standard deviation [SD] = 6.2) and 52 healthy control participants (mean age = 77.8 yr, SD = 6.4). All participants were assessed with the DLOTCA–G.

RESULTS. Internal consistency reliability showed moderate to high α coefficient levels in all domains (αs = .68–.85) except the Memory domain (α = .26). Both groups benefitted from mediation, but the stroke clients needed more concrete levels of mediation (Levels 3–5).

CONCLUSION. The addition of mediation to the LOTCA–G is effective in providing insights into clients’ cognitive status and learning potential. Our findings are similar to the results of the validation study for the DLOTCA for adults and support the use and benefits of the dynamic version.

OBJECTIVE. This preliminary study sought to determine whether the imagery perspective used during mental practice (MP) differentially influenced performance outcomes after stroke.

METHOD. Nineteen participants with unilateral subacute stroke (9 men and 10 women, ages 28–77) were randomly allocated to one of three groups. All groups received 30-min occupational therapy sessions 2×/wk for 6 wk. Experimental groups received MP training in functional tasks using either an internal or an external perspective; the control group received relaxation imagery training. Participants were pre- and posttested using the Fugl-Meyer Motor Assessment (FMA), the Jebsen–Taylor Test of Hand Function (JTTHF), and the Canadian Occupational Performance Measure (COPM).

RESULTS. At posttest, the internal and external experimental groups showed statistically similar improvements on the FMA and JTTHF (p < .05). All groups improved on the COPM (p < .05).

CONCLUSION. MP combined with occupational therapy improves upper-extremity recovery after stroke. MP does not appear to enhance self-perception of performance. This preliminary study suggests that imagery perspective may not be an important variable in MP interventions.

OBJECTIVE. We investigated the psychometric properties of the Flinn Performance Screening Tool (FPST) for people referred with symptoms of carpal tunnel syndrome (CTS).

METHOD. An occupational therapist collected data from 46 participants who completed the Functional Status Scale (FSS) and FPST after the participants’ nerve conduction velocity study to test convergent and contrasted-group validity.

RESULTS. Seventy-four percent of the participants had abnormal nerve conduction studies. Cronbach’s α coefficients for subscale and total scores of the FPST ranged from .96 to .98. Intrarater reliability for six shared items of the FSS and the FPST was supported by high agreement (71%) and a fair κ statistic (.36). Strong to moderate positive relationships were found between the FSS and FPST scores. Functional status differed significantly among severe, mild, and negative CTS severity groups.

CONCLUSION. The FPST shows adequate psychometric properties as a client-centered screening tool for occupational performance of people referred for symptoms of CTS.

PURPOSE. Recently, home health services have been a topic of increasing interest. Occupational therapy practice and utilization patterns in home care have not been the subject of recent research.

METHOD. I examined 65 publications addressing current occupational therapy practice in U.S. home health. Articles were analyzed to uncover factors influencing occupational therapy utilization and practice.

RESULTS. Results indicate that research has looked at a variety of typologies and efficacy measures for occupational therapy in home care. However, occupational therapy utilization and practice patterns in home health do not appear to be entirely consistent with research. I identify factors explaining this inconsistency and make research and practice recommendations.

CONCLUSION. Results suggest that system challenges limit the utilization and practice of occupational therapy to deliver expected outcomes in home health practice.

In this article, we present a small randomized controlled study evaluating the effect of a dual parent- and trainer-delivered qigong massage methodology on motor skills and sensory responses in 28 children under age 4 with developmental delay and motor tone abnormalities. Fourteen children had high motor tone as a result of cerebral palsy (CP), and 14 children had low motor tone as a result of Down syndrome. Multivariate analysis and post hoc analysis of variance showed large effect-size improvements in Peabody Gross Motor Scale (PGMS) Object Manipulation scores (p < .01) and large effect-size improvements in overall PGMS scores (p < .04) in treatment versus control groups after 5 mo intervention. Follow-up evaluation 10 mo from the start indicated continued improvement. Sensory responses showed no treatment effect. The results suggest further investigation of qigong massage as a promising avenue for research to improve motor skills in young children with CP and Down syndrome.

OBJECTIVE. To determine whether the Evaluation of Social Interaction (ESI) is sensitive enough to differentiate between people without identified diagnoses and those with neurologic or psychiatric disorders in terms of their observed quality of social interaction.

METHOD. Participants were age 16–69 and were without identified diagnoses (n = 304) or had neurologic (n = 77) or psychiatric (n = 104) disorders. They were evaluated using the ESI.

RESULTS. Nonparametric Kruskal–Wallis tests and post hoc Mann–Whitney U tests revealed that the group without identified diagnoses had significantly better quality of social interaction than did either group with disabilities (Us = 3,172 and 3,189, respectively; p ≤ .001).

CONCLUSION. The ESI is sensitive with regard to detecting differences in quality of social interaction among groups expected to differ, suggesting that it is valid for use when the desired purpose is to identify people with diminished quality of social interaction.

OBJECTIVE. We examined the effects of a tailored activity-pacing intervention on self-perceived joint stiffness in adults with osteoarthritis (OA).

METHOD. Thirty-two adults with hip or knee OA were randomized to a tailored or general activity-pacing intervention. Participants’ symptoms and physical activity over 5 days were used to tailor activity pacing. The outcome was self-perceived joint stiffness measured at baseline, 4 wk, and 10 wk. A linear mixed regression model was used.

RESULTS. The tailored group significantly improved in stiffness compared with the general group over time. We found a significantly different linear trend between groups (Time × Group, p = .046) in which the tailored group had decreasing stiffness over the three time points, denoting continued improvement. The general group’s stiffness improved from baseline to 4 wk but returned to baseline levels at 10 wk.

CONCLUSION. Tailoring activity pacing may be effective in sustaining improvements in self-perceived joint stiffness in adults with OA.

OBJECTIVE. We identified the extent of the need for interventions and assistive technology to prevent computer use problems in people with systemic sclerosis (SSc) and the accommodation strategies they use to alleviate such problems.

METHOD. Respondents were recruited through the Scleroderma Foundation. Twenty-seven people with SSc who used a computer and reported difficulty in working completed the Computer Problems Survey.

RESULTS. All but 1 of the respondents reported one problem with at least one equipment type. The highest number of respondents reported problems with keyboards (88%) and chairs (85%). More than half reported discomfort in the past month associated with the chair, keyboard, and mouse. Respondents used a variety of accommodation strategies.

CONCLUSION. Many respondents experienced problems and discomfort related to computer use. The characteristic symptoms of SSc may contribute to these problems. Occupational therapy interventions for computer use problems in clients with SSc need to be tested.

Daily challenges for occupational therapists and occupational therapy assistants are changing work environments and the desire to address the needs of their clients. This article highlights the need for occupational therapy practitioners to create personal strategic plans to prepare for their rapidly changing futures. Although AOTA’s Centennial Vision responds to the profession's future, practitioners must focus on their personal and professional roles and responsibilities. They also must engage in individual strategic planning. Sound individual strategic planning provides a means for practitioners to merge their fantasized views of occupational therapy with the reality of today's practice.

We reviewed 22 articles on children and youth published in 2011 in the American Journal of Occupational Therapy and organized the articles by level of research and research type according to a framework adapted from the International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2007). The largest percentage of articles described intervention effectiveness studies classified as Level III or IV. The bulk focused on the Body Function/Body Structure construct of the ICF, but as a whole the studies addressed all the constructs except Biomedical Molecular/Cellular. Rigor remains a concern, although laudable efforts have been made to increase strength of the evidence. Longitudinal, efficacy, and qualitative studies, as well as studies examining adolescents and the transition to adulthood, were absent from articles in this review and are important areas for future investigation. Several studies explicitly addressed intervention fidelity, an imperative in evidence-based research needed to move the profession toward the Centennial Vision.