American Journal of Occupational Therapy

OBJECTIVE. The purpose of this study was to examine the effectiveness of the Cognitive–Functional (Cog–Fun) intervention for young children with attention deficit hyperactivity disorder (ADHD).

METHOD. Nineteen children ages 5–7 yr diagnosed with ADHD were allocated to treatment and wait-list control groups. After the 12-wk intervention, the control group was crossed over to treatment. Follow-up was conducted 3 mo after treatment. Outcome measures included the Behavior Rating Inventory of Executive Function and the Canadian Occupational Performance Measure.

RESULTS. Before crossover, significant differences were found between groups in change scores on the outcome measures. After crossover, no significant differences were found in treatment effects, and significant moderate to large treatment effects were found for both COPM and BRIEF scores. Treatment gains were maintained at follow-up.

CONCLUSION. The study supports the effectiveness of the Cog–Fun intervention in improving occupational performance and executive functions in daily life for young children with ADHD.

OBJECTIVE. We conducted a meta-analysis to examine the association between early intervention and mental or neuromusculoskeletal and movement-related functions of children born low birthweight (LBW) or preterm.

METHOD. The meta-analysis included 16 studies that yielded 97 effects. Q and I ² values were used to determine heterogeneity. Publication bias was evaluated using Egger’s regression intercept test and a funnel plot.

RESULTS. The association between early intervention and either mental or neuromusculoskeletal and movement-related functions yielded a significant but small effect size (d = .219, p < .0001). Heterogeneity was statistically insignificant.

CONCLUSION. Participation in early intervention programs addressing mental or neuromusculoskeletal and movement-related functions in children born LBW or preterm results in significant improvements in these areas.

OBJECTIVE. This article describes the development, reliability, and validity of My Child’s Play (MCP), a parent questionnaire designed to evaluate the play of children ages 3–9 yr.

METHOD. The first phase of the study determined the questionnaire’s content and face validity. Subsequently, the internal reliability consistency and construct and concurrent validity were demonstrated using 334 completed questionnaires.

RESULTS. The MCP showed good internal consistency (α = .86). The factor analysis revealed four distinct factors with acceptable levels of internal reliability (Cronbach’s αs = .63–.81) and gender- and age-related differences in play characteristics; both findings attest to the tool’s construct validity. Significant correlations (r = .33, p < .0001) with the Parent as a Teacher Inventory demonstrate the MCP’s concurrent validity.

CONCLUSION. The MCP demonstrated acceptable reliability and validity. It appears to be a promising standardized assessment tool for use in research and practice to promote understanding of a child’s play.

The purpose of this study was to examine the internal structure of the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES), an assessment of household task participation for children. Rasch analysis was used to examine patterns of item response and scale structure with data collected from caregivers of 132 children and youth ages 6–14 yr with and without disabling conditions. Internal consistency was strong for the total measure and the subscales. The items in both subscales fit the measurement model, and the item difficulty order matched the expected pattern from harder to easier household task performance and degree of caregiver assistance. The sample distribution in the hierarchical continuum showed that younger participants and those with physical disabilities tended to score lower. Some inconsistencies in rating scale use suggest a need for further clarification of the scoring criteria for measurement coherence.

OBJECTIVE. We examined content and construct validity of Here’s How I Write: A Child’s Self-Assessment and Goal Setting Tool, to assess children’s perception of their handwriting and set child-directed goals.

METHOD. In Study 1, a content validity study, 6 occupational therapists and 2 educators assessed the need for this type of measure and examined the proposed items. Thirty-four occupational therapists and educators then completed an online survey examining the items. Study 2, a construct validity study, compared the self-ratings of 20 children with poor handwriting and 20 children with good handwriting in Grades 2–5 with their teachers’ ratings.

RESULTS. Results supported test content and indicated freedom from culture and gender bias. The assessment discriminated between good and poor writers. The relationship between teacher and student ratings was significant, although teachers of poor writers rated the children lower than the children rated themselves.

CONCLUSION. These studies provide support for the tool’s validity.

We conducted a longitudinal study to assess the continuing influence of developmental coordination disorder (DCD) on quality of life and participation. Ninety-six participants (25 in the DCD group, 30 in the borderline group, and 41 in the control group) ages 22–29 yr who had been screened for DCD 3–4 yr previously completed the Participation in Every Day Activities of Life, the Life-Satisfaction Questionnaire, and the World Health Organization Quality of Life (WHOQOL–BREF) instrument. Multivariate analysis of variance revealed a significant between-groups difference, F(7, 95) = 2.89, p = .001, η = 0.173, and post hoc analyses revealed that participants in the DCD and borderline groups scored lower overall on participation, quality of life, and life satisfaction. Linear regression found the Psychological Health domain of the WHOQOL–BREF to be a significant predictor of life satisfaction (B = 0.533; p = .001).

OBJECTIVE. We explored effects of cutaneous feedback and hump position on efficiency and comfort in mouse use with a splint. We also analyzed the relationship between anthropometric measurements (width of hand and length of hand, palm, and index) and the task performance.

METHOD. Thirty participants performed a computer task with two forms of mice (front hump and rear hump) and two kinds of wrist splints (dorsal and volar). Movement time and satisfaction scores were recorded.

RESULTS. No interaction effect (Hump Position × Splint Type) was found on movement time. Movement time was shorter for rear-hump mouse users than for front-hump mouse users. Movement time was also shorter for wearers of dorsal wrist splints than for wearers of volar wrist splints. Limited differences existed in the satisfaction scores. Participants with a longer index finger had shorter movement time.

CONCLUSION. Both dorsal wrist splints and rear-hump mice are recommended. Length of index finger positively correlated with task performance.

OBJECTIVE. A subgroup of patients benefiting most from robot-assisted therapy (RT) has not yet been described. We examined the predictors of improved outcomes after RT.

METHOD. Sixty-six patients with stroke receiving RT were analyzed. The outcome measures were the Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Stroke Impact Scale (SIS). The potential predictors were age, side of lesion, time since onset, Modified Ashworth Scale (MAS) scores, accelerometer data, Box and Block Test (BBT) scores, and kinematic parameters.

RESULTS. BBT scores were predictive of FMA (29%) and MAL (9%−15%) improvements. Reduced shoulder flexion synergy, as measured by less shoulder abduction during forward reach, and MAS–distal were predictive of WMFT–function improvements. MAS–distal was predictive of SIS–physical improvements. Demographic variables did not predict outcomes.

CONCLUSION. Manual dexterity was a valuable predictor of motor impairment and daily function after RT. Outcomes at different levels may have different predictors.

OBJECTIVE. We examined the interrater reliability and clinical utility of the Personal Care Participation Assessment and Resource Tool (PC–PART) in a rehabilitation setting.

METHOD. Ninety-six patients were recruited from the caseload of four occupational therapists. Patients were assessed on admission. Clinical utility was based on time to complete assessments.

RESULTS. Interrater reliability for the total score was very high (intraclass correlation coefficient = .91). Limits of agreement for the program indicated aggregate data from individual scores were within 1.3 units (range = −1.3 to 0.5) but individual scores would be within 10 units (range = −9.3 to 0.2). The PC–PART took 27 min to complete.

CONCLUSION. The PC–PART may have sufficient interrater reliability and clinical utility to evaluate program outcomes. The limits of agreement for rating individuals were relatively large, suggesting that it may be difficult to use the PC–PART to make clinical inferences about an individual patient.

OBJECTIVE. We examined the validity of one-screen versus three-screen driving simulators and their acceptability to middle-aged and older drivers.

METHOD. Participants aged 40–55 or 65 and older (N = 32) completed simulated drives first with a single monitor and then with a three-monitor setup, followed by pen-and-paper measures and an interview.

RESULTS. Mean differences between one- and three-screen drives were not statistically significant for Starting/Stopping and Passing/Speed. Correlations between the two drives indicated moderate positive linear relationships with moderate agreement. More errors occurred on the one-screen simulator for Signal Violation/Right of Way/Inattention, Moving in a Roadway, Turning, and Total Scores. However, for Moving in a Roadway, Turning, and Total Scores, correlations between drives indicated strong positive linear relationships. We found no meaningful correlation between workload, computer comfort, simulator discomfort, and performance on either drive. Participants found driving simulators acceptable.

CONCLUSION. Findings support the use of one-screen simulators. Participants were favorable regarding driving simulators for assessment.

OBJECTIVE. To investigate the performance of cognitively demanding instrumental activities of daily living (IADLs) among people with Parkinson’s disease (PD) without dementia.

METHOD. Seventy-seven participants with PD and 57 participants without PD underwent standardized, performance-based IADL evaluation using the Performance Assessment of Self-care Skills. Activity performance was rated for independence, adequacy, and safety.

RESULTS. The PD group had lower independence and adequacy scores than the non-PD group for almost every activity. Medication management, shopping, and sharp utensil use were the activities most sensitive to group differences. In the PD group, older age, lower Mini-Mental State Examination scores, and decreased motor function were associated with poorer IADL performance.

CONCLUSIONS. People with relatively early and mild PD demonstrated measurable deficits in the performance of cognitively demanding IADLs. This work highlights the importance of using objective assessments of IADL function to detect early functional changes in people with PD.

The American Occupational Therapy Association (AOTA) Evidence-Based Practice Project has developed a table summarizing the research opportunities on early childhood. The table provides an overview of the state of current available evidence on interventions within the scope of occupational therapy practice and is based on the systematic reviews from the AOTA Evidence-Based Practice Guidelines Series. Researchers, students, and clinicians can use this information in developing innovative research to answer important questions within the occupational therapy field.

OBJECTIVE. We examined the development, implementation, and effectiveness of a theory-based workshop to facilitate knowledge translation for occupational therapists addressing upper-limb poststroke sensory impairments.

METHOD. Nineteen therapists participated in a quasi-experimental pretest–posttest study that included an 8-hr evidence-based workshop designed using the Theory of Planned Behavior. We measured changes in knowledge, attitudes, and perceived behavioral control and intended behaviors regarding sensory impairment management, research utilization, and shared decision making.

RESULTS. We noted significant changes in knowledge, attitudes, and perceived behavioral control and intended behaviors about sensory impairment management, research utilization, and shared decision making and made recommendations for changes in recruitment strategies, outcome measures, and workshop content.

CONCLUSION. A theory-based workshop can potentially affect knowledge, attitudes, and intended behaviors about sensory impairment management, research utilization, and shared decision making. A randomized controlled trial evaluating this intervention is warranted and will potentially improve understanding of methods to facilitate knowledge translation.

OBJECTIVE. Mirror therapy (MT) is a potential intervention to improve function after stroke. How to apply this intervention in practice is not clear. This case report illustrates the feasibility and effectiveness of a self-administered home-based MT program.

METHOD. A home-based MT program was practiced over 5 wk. The participant was encouraged to use MT for 30 min 5×/wk. Therapist contact occurred 1×/wk to monitor performance. An independent evaluator administered three outcome measures pre- and postintervention: Upper Extremity Sensory and Pain sections of the Fugl-Meyer Assessment; Jebsen–Taylor Test of Hand Function, and the Manual Ability Measure–20.

RESULTS. The participant engaged in a mean of 39.23 (±7.44) min of MT per day and used a variety of the recommended activities. Change scores indicated improvement on all of the included outcome measures.

CONCLUSION. This case report suggests that a predominantly self-administered home-based MT program is feasible and effective at improving function after stroke.

Occupational therapists are part of multidisciplinary teams supporting infants with feeding and eating difficulties, including problems related to initiation and continuation of breastfeeding. We have the opportunity to expand our role in breastfeeding promotion by also defining breastfeeding as a child-rearing and health management and maintenance occupation and broadening our clientele to include health and wellness populations. The use of a health promotion approach enables occupational therapy practitioners to better address environmental and contextual barriers to engagement in breastfeeding, barriers also encountered by healthy populations. Healthy People 2020 calls for increased rates of exclusive breastfeeding in the United States, given evidence of the health benefits of breastfeeding for infants, women, and society. Occupational therapists are well positioned to assist individuals, organizations, and populations in establishing habits and routines supportive of continued breastfeeding while lessening environmental and contextual barriers. Occupational therapists should consider emerging practice opportunities as consultants for breastfeeding promotion.

OBJECTIVE. We describe the methodological quality of recent studies on instrument development and testing published in the American Journal of Occupational Therapy (AJOT).

METHOD. We conducted a systematic review using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist to appraise 48 articles on measurement properties of assessments for adults published in AJOT between 2009 and 2013.

RESULTS. Most studies had adequate methodological quality in design and statistical analysis. Common methodological limitations included that methods used to examine internal consistency were not consistently linked to the theoretical constructs underpinning assessments; participants in some test–retest reliability studies were not stable during the interim period; and in several studies of reliability and convergent validity, sample sizes were inadequate.

CONCLUSION. AJOT’s dissemination of psychometric research evidence has made important contributions to moving the profession toward the American Occupational Therapy Association’s Centennial Vision. This study’s results provide a benchmark by which to evaluate future accomplishments.