American Journal of Occupational Therapy

OBJECTIVE. This study examined the effectiveness of occupational performance coaching in improving children’s and mothers’ occupational performance and mothers’ parenting self-competence.

METHOD. A one-group time-series design was used to evaluate changes in children’s (n = 29) and mothers’ (n = 8) occupational performance at four time points: (1) pre–wait list, (2) preintervention, (3) postintervention, and (4) follow-up.

RESULTS. Significant improvements in occupational performance occurred postintervention for children, F(1, 78) = 153.72, p < .001, η² = .86, and mothers, F(1, 78) = 153.72, p < .001, η² = .86, that were maintained 6 wk after intervention. Mothers’ self-competence in parenting also improved, F(1, 72) = 17.36, p < .001, η² = .42.

CONCLUSION. Findings provide preliminary evidence supporting the effectiveness of occupational performance coaching in improving children’s and mothers’ occupational performance and mothers’ parenting self-competence. Improvements were sustained and appeared to generalize to other areas of performance.

This study examined the effectiveness of two approaches used in elementary schools to improve children’s handwriting. Participants were 72 New York City public school students from the first and second grades. A nonequivalent pretest–posttest group design was used in which students engaged in handwriting activities using two approaches: intensive handwriting practice and visual–perceptual–motor activities. Handwriting speed, legibility, and visual–motor skills were examined after a 12-wk Handwriting Club using multivariate analysis of variance. The results showed that students in the intensive handwriting practice group demonstrated significant improvements in handwriting legibility compared with students in the visual–perceptual–motor activity group. No significant effects in handwriting speed and visual–motor skills were found between the students in intensive handwriting practice group and the students in visual–perceptual–motor activities group. The Handwriting Club model is a natural intervention that fits easily into existing school curriculums and can be an effective short-term intervention (response to intervention Tier II).

OBJECTIVES. The level of children’s motor skill proficiency may be an important determinant of their physical activity behaviors. This study assessed the efficacy of an intervention on gross motor skill performance, physical activity, and weight status of preschoolers.

METHOD. The Food Friends: Get Movin’ With Mighty Moves^® program was conducted in four Head Start centers. Measurements included the Peabody Developmental Motor Scales, pedometer counts, and body mass index (BMI) z scores.

RESULTS. The intervention led to significant changes in gross motor skills in the treatment group (n = 98) compared with the control group (n = 103) and was a strong predictor of overall gross motor performance (gross motor quotient), locomotor, stability, and object manipulation skills. No intervention effect was found for physical activity levels or weight status.

CONCLUSION. The intervention dose was adequate for enhancing gross motor skill performance but not for increasing physical activity levels or reducing BMI.

OBJECTIVE. This study describes the continued development of the Life Participation for Parents (LPP), a measurement tool to facilitate family-centered pediatric practice.

METHOD. LPP questionnaires were completed by 162 parents of children with special needs receiving intervention at 15 pediatric private practice clinics. Results were analyzed to establish instrument reliability and validity.

RESULTS. Good internal consistency (α = .90) and test–retest reliability (r = .89) were established. Construct validity was examined through assessment of internal structure and comparison of the instrument to related variables. A principal components analysis resulted in a two-factor model accounting for 43.81% of the variance. As hypothesized, the LPP correlated only moderately with the Parenting Stress Index–Short Form (r = .54). The variables of child’s diagnoses, age, and time in therapy did not predict parental responses.

CONCLUSION. The LPP is a reliable and valid instrument for measuring satisfaction with parental participation in life occupations.

OBJECTIVE. To determine how safe-patient-handling (SPH) equipment is used in rehabilitation and how it affects therapists, patients, and therapy practice.

METHOD. We used a qualitative, instrumental case study design. Thirty-five occupational and physical therapist practitioners from three facilities participated in the study.

RESULTS. Therapists reported a broad range of applications for equipment (e.g., functional mobility and neuromusculoskeletal function). They reported that SPH equipment increased treatment options for therapists and increased participation options for patients, although equipment limitations exist. Three themes emerged from the analysis: choice, potential, and safety.

CONCLUSION. SPH equipment has therapeutic applications in rehabilitation, especially for medically complex or bariatric patients. Therapists in this study engaged in a highly individualized, complex process of decision making when selecting and using SPH devices in rehabilitation. More research to refine and test therapeutic uses is necessary.

OBJECTIVE. We identified the predictive factors of change in quality of life (QOL) after a distributed form of constraint-induced therapy (dCIT) among stroke survivors.

METHOD. Seventy-four participants were treated with dCIT. We identified eight potential determinants of change: age, gender, side of lesion, time since stroke, cognitive status, motor impairment of the upper extremity, activities of daily living (ADLs), and instrumental ADLs (IADLs). The Stroke-Specific Quality of Life Scale (SS–QOL) was used to assess QOL.

RESULTS. Right-sided lesion and onset >17 mo earlier determined greater improvement in the SS–QOL Energy domain. Onset >10 mo earlier, poorer IADL performance, and age >68 yr predicted improvement in the Family Role, Mobility, and Mood domains, respectively.

CONCLUSION. Side of lesion, time since stroke, IADL performance, and age were the most important determinants of QOL in patients receiving stroke motor rehabilitation.

Significant data exist for the personal, environmental, and occupational risk factors for carpal tunnel syndrome. Few data, however, explain the interrelationship of tissue morphology to these factors among patients with clinical presentation of median nerve pathology. Therefore, our primary objective was to examine the relationship of various risk factors that may be predictive of subjective reports of symptoms or functional deficits accounting for median nerve morphology. Using diagnostic ultrasonography, we observed real-time median nerve morphology among 88 participants with varying reports of symptoms or functional limitations resulting from median nerve pathology. Body mass index, educational level, and nerve morphology were the primary predictive factors. Monitoring median nerve morphology with ultrasonography may provide valuable information for clinicians treating patients with symptoms of median nerve pathology. Sonographic measurements may be a useful clinical tool for improving treatment planning and provision, documenting patient status, or measuring clinical outcomes of prevention and rehabilitation interventions.

OBJECTIVE. We examined the occupational performance issues facing young U.S. veterans (aged 20–29 yr) who served in Iraq and Afghanistan. Perceived challenges in occupational performance, the most common mental health and brain injuries of war, and motivations for participation in daily occupations upon return to civilian life were identified.

METHOD. Thirty young veterans from Operation Iraqi Freedom and Operation Enduring Freedom were interviewed using the Canadian Occupational Performance Measure (Law et al., 2005). They were also screened for posttraumatic stress disorder, traumatic brain injury, major depression, and alcohol abuse or dependency.

RESULTS. The top five occupational performance challenges were engagement in relationships, school, physical health, sleeping, and driving. The health conditions screened positive for 23%–77% of respondents.

CONCLUSION. This study identified challenges faced by today’s young veterans when reintegrating into the community and daily life. Strategies for occupational therapy practitioners to aid veterans in community reintegration are discussed.

PURPOSE. To understand the medication routines used by older adults taking four or more medications daily.

METHOD. One hundred forty-nine community-dwelling older adults were interviewed about the individual routines, storage locations, equipment, and assistance that enabled their adherence to a medication regimen. A subsample of 84 older adults was observed completing one medication routine in their home environments.

FINDINGS. Medication habits were embedded in mealtime, wake-up, and sleep routines for 91% of the sample. Participants developed unique, individualized behaviors for taking medications that were choreographed within broader daily routines. The primary locations for storing medications were the kitchen and bathroom. Equipment used to promote adherence was primarily pillboxes or self-made adaptations. More than 50% of the entire sample required some type of assistance related to medication adherence.

IMPLICATIONS. Findings support the role of occupational therapists in collaborating with clients to develop individualized medication routines to promote medication adherence.

Despite the potential benefits of powered mobility, many older adults do not have access to this technology. To date, few studies have explored how prescribers make decisions regarding provision of powered mobility. Therefore, we undertook a qualitative study to develop a better understanding of prescribers’ attitudes toward and practices with older adult candidates for powered mobility devices. Our analysis of 10 in-depth interviews identified three main themes: (1) “Deciding who should be entitled” explored how therapists decided who should have access to powered mobility, (2) “power wheelchair negotiation” described the discord between clients and therapists that became apparent during this process, and (3) “practical considerations” revealed how contextual factors shaped the provision of powered mobility. The findings suggest that the ways in which powered mobility is funded, provided, and accommodated should be improved so that more older adults have access to these devices and can use them to their full potential.

We determined the concurrent criterion validity of the Safe Driving Behavior Measure (SDBM) for on-road outcomes (passing or failing the on-road test as determined by a certified driving rehabilitation specialist) among older drivers and their family members–caregivers. On the basis of ratings from 168 older drivers and 168 family members–caregivers, we calculated receiver operating characteristic curves. The drivers’ area under the curve (AUC) was .620 (95% confidence interval [CI] = .514–.725, p = .043). The family members–caregivers’ AUC was .726 (95% CI = .622–.829, p ≤ .01). Older drivers’ ratings showed statistically significant yet poor concurrent criterion validity, but family members–caregivers’ ratings showed good concurrent criterion validity for the criterion on-road driving test. Continuing research with a more representative sample is being pursued to confirm the SDBM’s concurrent criterion validity. This screening tool may be useful for generalist practitioners to use in making decisions regarding driving.

Knowledge translation has emerged as a critical force across health research, funding, policy, and practice. Occupational therapy finds itself on the periphery of this emerging field, but opportunities specific to occupational therapy systems can facilitate a shift in which the profession develops its role as a key player. As occupational therapy increasingly recognizes the essential role of knowledge translation in health care, strategic action to create knowledge translator roles, technology, resources, opportunities, and communities of practice will be needed to align occupational therapy academic and health care systems with knowledge translation imperatives that increasingly shape the health care landscape.

OBJECTIVE. The Autism Work Skills Questionnaire (AWSQ), a new, comprehensive self-report assessment of a person’s vocational profile, was developed to help produce a good person–job match. This preliminary study was aimed at developing the questionnaire and determining its content validity and internal consistency.

METHOD. Forty-six adults with high-functioning autism spectrum disorder (HFASD), ages 18–39, were interviewed with the questionnaire. A two-phase study was conducted: (1) constructing the questionnaire and determining its content validity and (2) ascertaining internal consistency reliability.

RESULTS. We found that the AWSQ had initial content validity and moderate to high internal consistency reliability (Cronbach’s α = .64–.90).

CONCLUSION. The AWSQ can be a useful clinical and research tool in occupational therapy for evaluating work skills of adults with HFASD. Further studies with larger samples and including both typically developing individuals and individuals with HFASD are required to further support the questionnaire’s reliability and validity.

This study examined reliability of the Health Enhancement Lifestyle Profile–Screener (HELP–Screener), a 15-item self-report questionnaire serving as an initial screening of lifestyle behaviors for older adults. The internal consistency of HELP–Screener was analyzed using data derived from a sample of 483 older adults. The resultant Cronbach’s α coefficient of .74 indicated an acceptable level of internal consistency. The test–retest reliability study with 90 participants yielded an intraclass correlation coefficient of .93, indicating a high degree of temporal stability of the instrument at the scale level. Moreover, good to excellent degrees of agreement found through the κ statistic (k _s = .76–.96) and percentage of agreement (96%–99%) between the test and retest scores of each item further supported HELP–Screener’s test–retest reliability at the item level. Future studies should determine other aspects of psychometric properties and clinical suitability of this new instrument.