American Journal of Occupational Therapy

Pediatric occupational therapy practitioners face a complex and ever-changing health care environment, creating many challenges and opportunities. P4 medicine is a systems approach to health care that emphasizes proactive wellness over reactive acute care disease management. The four Ps of P4 medicine stand for predictive, personalized, preventive, and participatory, concepts that align well with the practice of pediatric occupational therapy. P4 medicine offers a model for pediatric occupational therapy practitioners to demonstrate the value of occupational therapy services.

Systematic reviews of literature relevant to early intervention and early childhood services are important to the practice of occupational therapy. We describe the five questions that served as the focus for the systematic reviews of the effectiveness of occupational therapy interventions in early intervention and early childhood services. We include 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 themes of the results; the strengths and limitations of the findings; and implications for practice, education, and research are presented.

This systematic review synthesized the research on interventions used by occupational therapy practitioners to promote social–emotional development in young children (birth–5 yr) with or at risk for disabilities. After a comprehensive search of the research literature, 23 studies were reviewed and then synthesized into five themes: (1) touch-based interventions to enhance calming and parent–infant bonding, (2) relationship-based interventions to promote positive caregiver–child interactions, (3) joint attention interventions, (4) naturalistic preschool interventions to promote peer-to-peer engagement, and (5) instruction-based interventions to teach children appropriate social behaviors. The interventions for infants primarily involved coaching parents in specific strategies to promote positive interactions; interventions for preschool-age children typically involved encouraging peer support, instructing children, and applying naturalistic behavioral techniques to develop higher-level social competence. The studies demonstrated low to moderate positive effects for interventions used by occupational therapy practitioners to improve social–emotional development across ages, diagnoses, and settings.

Research articles on the effectiveness of feeding interventions for infants and young children were identified, appraised, and synthesized. Thirty-four studies met the inclusion criteria and were reviewed. Three broad intervention themes regarding feeding approaches were identified on the basis of their theoretical orientations. These three feeding approaches were (1) behavioral interventions, (2) parent-directed and educational interventions, and (3) physiological interventions. Synthesis of the evidence suggested that various feeding approaches may result in positive outcomes in the areas of feeding performance, feeding interaction, and feeding competence of parents and children. This synthesis of empirical evidence supporting interventions for feeding problems provides a foundation for future research to define the types of outcomes that can be expected for children with different diagnoses or functional impairments and to develop best practice guidelines.

We examined the research evidence for interventions used in occupational therapy to promote the motor performance of young children ages 0–5 yr. We identified 24 trials, Levels I–III, that met our review criteria. The studies fell into three categories: (1) developmental interventions for infants (ages 0–3 yr), (2) interventions for young children with or at risk for cerebral palsy (CP), and (3) visual–motor interventions for preschool children (ages 3–5 yr). Developmental interventions showed low positive short-term effects with limited evidence for long-term effects, and findings on the benefits of neurodevelopmental treatment were inconclusive. Interventions using specific protocols for children with CP resulted in positive effects. Visual–motor interventions for children with developmental delays (ages 3–5 yr) resulted in short-term effects on children’s visual–motor performance. Of the intervention approaches used in occupational therapy, those that embed behavioral and learning principles appear to show positive effects.

This systematic review examined the research evidence for interventions used by occupational therapists to improve cognitive development in children from birth to age 5. Thirteen studies met the inclusion criteria and were reviewed by three teams of two people. From the selected articles, which described Level I and IV studies, two general categories emerged: (1) developmental interventions and (2) joint attention interventions. Developmental interventions occurred in neonatal intensive care units, home, child care centers, and preschools. Synthesis of the articles indicates that developmental interventions result in gains in early cognitive development (e.g., infant and preschool age) with inconclusive evidence for gains through school age. Educating parents of preterm infants to be more sensitive to their child’s needs and more responsive in interactions increased cognitive outcomes and joint attention. Interventions using joint attention enhanced generalization to novel situations and increased play, language, and social interactions in preschoolers with autism. Further studies that describe intervention strategies used to enhance cognitive functioning to promote preliteracy skills such as joint attention, imitation, memory, problem solving, and decision making and are conducted by occupational therapists are needed.

Consideration of the evidence for all aspects of service delivery is a growing relevant concern of occupational therapists, including those providing early intervention to children and families. We conducted a review of the literature to uncover what evidence existed for determining the effectiveness of different service delivery models and methods used to improve occupational performance for children and families who receive early intervention services. Through a comprehensive search, we reviewed and synthesized studies, finding common themes of family-centered and routine-based approaches, service setting, and the inclusion of parent participation and training. Families consistently reported positive perceptions of family-centered and routine-based approaches. Parent participation and training resulted in positive outcomes. No specific setting or method of service delivery was identified as clearly most effective, with most studies reporting combined approaches and environments for interventions.

We examined the effects of visual rehabilitation, including a chromatic luminance discrimination program and a fixation training program, on a 6-yr-old boy with severe visual impairment. Single-subject ABA and AB designs were used. The programs were conducted 2×/wk and included 6 to 7 sessions for the baseline phase and 10 to 11 sessions for the intervention phase. Play was integrated into the visual training programs. Goggle visual evoked potential (VEP) testing was used to evaluate neural activity in the primary visual cortex. Correct responses increased and response times were shortened after training in luminance discrimination. The total and maximum fixation time also improved, as did P100 latency and amplitude of VEPs. While walking, the boy was able to detect obstacles he had not noticed before training. The results indicate the value of visual training and the possibility of brain plasticity in a child with severe visual impairment.

This study investigated the effects of wearing a wrist support splint for 8 wk and receiving a formal education program on patients with carpal tunnel syndrome (CTS), as well as factors associated with patients’ desire to seek surgical intervention. Participants were recruited from a hospital surgical wait list and randomly assigned to an intervention group (n = 30) or a control group (n = 24). Significant improvements in measures of symptom severity and functional status over the duration of the study appeared in the intervention group but not in the control group. Logistic regression for the intervention group showed that symptom severity (odds ratio [OR] = 1.53, 95% confidence interval [CI] [1.20–1.93]), functional deficits (OR = 1.31, 95% CI [1.08–1.57]), pain score (OR = 1.25, 95% CI [1.11–1.61]), and symptom duration (OR = 1.11, 95% CI [1.01–1.24]) were positively associated with the desire to seek surgical intervention. This conservative CTS treatment program conducted by occupational therapists can improve symptoms and hand function in CTS patients.

OBJECTIVE. This article describes a performance-based measure of executive function, the Multiple Errands Test–Revised (MET–R), and examines its ability to discriminate between people with mild cerebrovascular accident (mCVA) and control participants.

METHOD. We compared the MET–R scores and measures of CVA outcome of 25 participants 6 mo post-mCVA and 21 matched control participants.

RESULTS. Participants with mCVA showed no to minimal impairment on measures of executive function at hospital discharge but reported difficulty with community integration at 6 mo. The MET–R discriminated between participants with and without mCVA (p ≤ .002).

CONCLUSION. The MET–R is a valid and reliable measure of executive functions appropriate for the evaluation of clients with mild executive function deficits who need occupational therapy to fully participate in community living.

Consumer-oriented recovery among people with mental illness has been discussed for more than two decades, but few reliable and valid recovery measurements are currently available. This study used Rasch methods to assess the Mental Health Recovery Measure (MHRM). Participants were 156 adults with mental illness who lived in the community. After the Rasch analyses, the MHRM was modified to a 26-item measure with a 4-point Likert scale. Unidimensionality was confirmed for the revised MHRM, and it also showed proper rating scale functioning and high reliability. The revised MHRM is sufficient to assess only those in the initial and middle stages of recovery. More high-recovery-level items are needed to assess people in a high-recovery stage. Occupational therapists can use the revised MHRM in future quantitative studies and program evaluation.

OBJECTIVE. This study sought to determine interinstrument reliability of the Jamar electronic dynamometer and pinch gauge compared with the commonly used Jamar hydraulic dynamometer and B&L Engineering mechanical pinch gauge.

METHOD. Twenty men and 20 women were tested for grip strength with the two different dynamometers, and 17 men and 25 women were tested for lateral pinch strength with the two different pinch gauges.

RESULTS. Grip strength measurements were approximately 10% higher with the hydraulic dynamometer, and lateral pinch strength measurements were approximately 18% higher with the mechanical pinch gauge. Paired t tests and intraclass correlation coefficients (ICCs) were used for statistical analyses. The two-tailed p value was <.0001, and the ICC indicated poor to moderate reliability.

CONCLUSION. When retesting patients, it is recommended that occupational therapists use the same instrument to measure hand strength because interinstrument reliability may be lacking.

OBJECTIVE. We examined agreement of data between self-reported and objectively assessed exercise adherence among women with systemic lupus erythematosus.

METHOD. Eleven participants completed weekly exercise logs on date and duration of exercise during a 10-wk Wii Fit™ home-based program. Afterward, exercise data from the log were compared with those recorded in the Wii console.

RESULTS. Of the paired data, the mean duration of exercise recorded in the Wii was 29.5 min and that recorded in the log was 33.3 min. The composite intraclass correlation for exercise duration between exercise log and the Wii Fit was 0.4. The 95% limits of agreement indicated large between-subjects variability.

CONCLUSION. Exercise logs exhibit a marginally acceptable agreement with Wii estimation of exercise duration at a group level. However, caution should be applied when using the exercise log as a measure of a person’s exercise behavior because of the tendency to overreport.

Many articles have been written on the barriers to and facilitators of the use of evidence in practice in nursing and medicine, but to date no extensive review has been published of the literature on evidence-based practice (EBP) supports in occupational therapy. This article presents the results of a scoping review that examined factors that support the integration of research into practice. A review of 69 articles revealed four themes: (1) attitudes toward, perceptions of, confidence in, and use of research and EBP; (2) factors that support the use of research in practice; (3) effects of interventions targeting changes in knowledge, attitudes, skills, behaviors, and evidence-based practices; and (4) identification of the processes involved in the acquisition of EBP skills and their application in clinical practice. A process that integrates client-centered practice, structured reflection, case application, and peer consultations within a scholarship of practice model facilitates occupational therapists’ evaluation and integration of research evidence.

We undertook a content analysis of 192 American Journal of Occupational Therapy articles published from 1947 to 2010 to understand and explicate the emergence of scholarship within the profession. Scholarship includes scientific inquiry, empirical research, and other forms of inquiry. We identified and coded three aspects of the development of scholarship: argument, methodological rigor, and occupational focus. All three aspects increased over the evaluated period, during which substantial changes occurred in the profession’s practice and access to higher education. We see the development of scholarship as aligned with the claiming of the profession’s independence and voice.

This article describes a review of articles on productive aging published in the American Journal of Occupational Therapy (AJOT) during 2012 in light of the Centennial Vision charge of supporting practice through evidence. Seventeen AJOT articles published in 2012 specifically addressed productive aging. Of 6 Level I studies, 4 were systematic reviews that identified effective occupational therapy interventions for community-dwelling older adults; 1 randomized controlled trial examined the effectiveness of writing life reviews for residents of senior residences, and 1 meta-analysis investigated the effectiveness of fall-related efficacy and engagement in activity or occupation. Two Level II studies and 2 Level III studies produced support for the effectiveness of individual and group-based occupational therapy interventions. Of 7 descriptive studies addressing a variety of areas, 4 addressed the reliability and validity of assessments. In 2012, AJOT published more and higher quality studies addressing a variety of issues related to productive aging.