American Journal of Occupational Therapy

The pull of education is a powerful engine for societal change. Education is a values-driven product with specific and objective aims that serve society. The values of professional occupational therapy education were laid down at the field’s inception, although they have changed with the passage of time and in response to the profession’s and society’s occupational needs. Learning is different from education and is an individual process that requires facilitators with well-honed pedagogies if it is to fuel the engine pulling the profession forward. Keeping occupation as the central core of the profession serves as a necessary filter that allows more diligent thinking and linking between occupation and other relevant topics. Living life to its fullest—our own lives and the lives of our service recipients—demonstrates progress in the idiosyncratic arrangement of habits and routines that are personally meaningful, socially satisfying, and culturally relevant.

This special issue of the American Journal of Occupational Therapy includes summaries from a systematic evidence-based literature review of occupational therapy and driving and community mobility for older adults. Since the previous review on this topic in 2008, the cohort of 78 million baby boomers began turning 65 in January 2011. As a group, this cohort is more likely to have longer life expectancy, stay in the workforce longer, and age in place in the community. Is the occupational therapy profession ready for the potential demand for driving rehabilitation services from this generation of older drivers who grew up with the automobile and are dependent on it for access to and participation in their communities?

Systematic reviews of literature relevant to driving and community mobility for 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 assessments and interventions for driving and community mobility for older adults. 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 the implications for practice, education, and research are presented.

This systematic review synthesizes the research on interventions used by occupational therapy practitioners to address cognitive and visual function, motor function, driving skills, self-regulation and self-awareness, and the role of passengers and family involvement in the driving ability, performance, and safety of older adults. After a comprehensive search of the research literature, 29 studies were reviewed and synthesized into five themes: (1) educational interventions including family education, (2) cognitive–perceptual training, (3) interventions addressing physical fitness, (4) simulator training, and (5) behind-the-wheel training. Outcome measures used in the studies included changes in knowledge through speed of processing, physical and cognitive skills predicted to reduce crash risk, simulated driving, and real-world driving. The studies demonstrated low to moderate positive effects for interventions used by occupational therapy practitioners to improve older driver performance.

This systematic review synthesizes the research on screening and assessment tools used to determine older adults’ fitness to drive. After a comprehensive search of the literature targeting tools commonly used by occupational therapists, 64 studies were reviewed and synthesized. The evidence demonstrated that a single tool measuring cognition, vision, perception, or physical ability individually is not sufficient to determine fitness to drive. Although some tools have stronger evidence than others, this review supports using different and focused assessment tools together for specific medical conditions. Results indicate that behind-the-wheel assessment remains the gold standard for driving evaluation; however, emerging evidence for observation of complex instrumental tasks of daily living and driving simulation supports further investigation with these tools.

An updated systematic review of literature related to the effects of driver licensing policies, community mobility programs, and driving cessation programs on older adult performance and participation was completed as a part of the American Occupational Therapy Association’s Evidence-Based Literature Review Project. The results revealed that relicensing policies instituted by states yield inconsistent results in terms of reducing traffic crashes, traffic violations, and traffic-related fatalities. The evidence related to community mobility and driving cessation programs has suggested that programming to support the transition from driving to other modes of mobility can be beneficial for older adults and their family members. In addition, community contexts that are supportive of pedestrian travel significantly increase this mode of mobility. This evidence-based review informs occupational therapy practice and suggests that increased therapeutic attention should be directed toward supportive transitions from driving and sustaining community mobility for optimal engagement and participation.

This study examined the effectiveness of Write Start, a handwriting and writing program cotaught by teachers and occupational therapists for first-grade children. Four classrooms (n = 80) received the Write Start program, and four (n = 58) received standard handwriting and writing instruction. Two teachers and an occupational therapist implemented the 24-session manualized program, which included station teaching and individualized supports. The program emphasized practice in small groups in which the coteaching team provided students with frequent feedback, encouraged self-evaluation, and facilitated peer modeling and peer evaluation. Students who completed the Write Start program improved more in handwriting legibility and speed than the group receiving standard instruction. Writing fluency and written composition were no different between groups at posttest; however, writing fluency was significantly higher for Write Start students at 6-mo follow-up. Write Start students with low legibility at baseline made significant improvements, suggesting that the program may benefit students at risk for handwriting and writing problems.

OBJECTIVE. This study evaluated a parent-delivered intervention aiming to address the social difficulties of children with attention deficit hyperactivity disorder (ADHD). The intervention was evaluated from three perspectives: effectiveness, feasibility, and appropriateness.

METHOD. This one-group pretest–posttest study included 5 children with ADHD and their parents, who had previously participated in a therapist-delivered play-based intervention. The 7-wk parent-delivered intervention involved home modules (including a DVD, manual, and play dates with a typically developing playmate) and three therapist-led clinic-based play sessions. The Test of Playfulness was used as a pre- and postintervention and follow-up measure. Parents were interviewed 1 mo following the intervention, and data were analyzed for recurring themes.

RESULTS. Children’s social play outcomes improved significantly from pretest to 1-mo follow-up (Z = 2.02, p = .04, d = 1.0). Three themes emerged: the clinic play environment as a sanctuary, parental barriers to intervention delivery, and tools for repeating learned lessons.

CONCLUSION. The parent-delivered intervention demonstrated preliminary evidence for feasibility and effectiveness. Further research is warranted regarding appropriateness.

OBJECTIVE. To identify psychometric properties of the Home Safety Self-Assessment Tool (HSSAT) to prevent falls in community-dwelling older adults.

METHOD. We tested content validity, test–retest reliability, interrater reliability, construct validity, convergent and discriminant validity, and responsiveness to change.

RESULTS. The content validity index was .98, the intraclass correlation coefficient for test–retest reliability was .97, and the interrater reliability was .89. The difference on identified risk factors between the use and nonuse of the HSSAT was significant (p = .005). Convergent validity with the Centers for Disease Control and Prevention Home Safety Checklist was high (r = .65), and discriminant validity with fear of falling was very low (r = .10). The responsiveness to change was moderate (standardized response mean = 0.57).

CONCLUSION. The HSSAT is a reliable and valid instrument to identify fall risks in a home environment, and the HSSAT booklet is effective as educational material leading to improvement in home safety.

OBJECTIVE. The objectives of this study were to better understand the cognitive profile of adults with attention deficit hyperactivity disorder (ADHD), their occupational performance, and their quality of life (QoL) and to examine the validity of a cognitive–functional evaluation (CFE) battery for these adults.

METHOD. Eighty-one adults with ADHD and 58 without ADHD completed ADHD symptom ratings, the Behavior Rating Inventory of Executive Function–Adult Version, and the Adult ADHD Quality-of-Life Scale. An occupational performance interview was administered to the ADHD group.

RESULTS. A broad range of occupational concerns were reported. We found significant differences between groups on all measures. In the ADHD group, we found medium significant correlations among the measures.

CONCLUSION. Adults with ADHD experience cognitive and functional difficulties in their daily lives associated with QoL. The results support the use of a CFE battery that has been shown to be sensitive and specific for these adults.

OBJECTIVE. This study explored factors related to changes in the time parents spent with their children with obesity and associated decreases in children’s body mass index (BMI) z-scores after an occupation-focused intervention.

METHOD. Parents participated in a 1-yr occupation-focused intervention to promote healthy family lifestyles. Data on 40 parents of 22 children with obesity ages 4–6 yr were collected before and after intervention and analyzed using linear and multiple regression methods.

RESULTS. Parents increased time spent with their children by an average of 91 min/day. Parents’ finances, perceived satisfaction in daily occupations, low BMI, and mastery at inclusion were associated with increased time spent with their children. Mothers’ subjective health and high mastery and fathers’ perceived occupational value and education explained 67% of the variance in children’s BMI z-scores.

CONCLUSION. The results indicate important factors to consider in developing interventions that facilitate occupational engagement and health among children with obesity and their families.

OBJECTIVE. We describe the development and preliminary psychometric examination of the DPSQ for identifying drawing difficulties in preschool children.

METHOD. Teachers completed the DPSQ for 78 children ages 3–6 yr from 4 preschools. Children drew age-appropriate geometric forms of the Visual–Motor Integration (VMI) test on a digitizing tablet. We examined psychometric properties of the DPSQ and analyzed group membership.

RESULTS. Internal consistency was high (α = .82). Significant correlations were found between DPSQ and VMI scores indicating in-air time (r = .37, p = .002) and pressure on the writing tool (r = .32, p = .007). The typical and at-risk groups differed significantly in VMI and DPSQ scores, t(76) = 5.6, p = .001. The DPSQ mean score differentiated between 76% of children with and without visual–motor deficits.

CONCLUSION. The DPSQ is a useful tool for teachers and occupational therapy practitioners for indicating visual–motor deficits and potential handwriting problems.

OBJECTIVE. We sought to describe occupational therapy practitioners’ perceived levels of preparedness for and involvement in school-based Response to Intervention (RtI) initiatives.

METHOD. We mailed a survey to a random sample of 1,000 practitioners from the American Occupational Therapy Association’s Early Intervention and School Systems Special Interest Section.

RESULTS. Of 295 returned surveys (29.9% response rate), 19 were excluded because of missing or incomplete data. Three-quarters of respondents (77.6%) reported that their districts implemented RtI. Two-thirds of respondents (66.3%) indicated that lack of resources limited their involvement in RtI; two-thirds (67%) said that district guidelines that describe expectations for practitioners’ involvement would help increase their participation. Many respondents cited the need for continuing education and supported moving from a caseload to a workload model.

CONCLUSION. Occupational therapy practitioners would benefit from specific district guidelines outlining the services they are able to provide within the context of RtI.

OBJECTIVE. The Executive Function Performance Test (EFPT) is a reliable and valid performance-based assessment of executive function for people with stroke. The objective of this study was to enhance the clinical utility of the EFPT by developing and testing additional tasks for the EFPT in the Alternate EFPT (aEFPT).

METHOD. We performed a cross-sectional study with poststroke participants (n = 25) and healthy control participants (n = 25). All participants completed a neuropsychological assessment battery and both the EFPT and the aEFPT.

RESULTS. No statistically significant differences were found between the EFPT and the aEFPT when examining total scores, construct scores, and two overall task scores. Correlations between the aEFPT and the neuropsychological measures were adequate to strong (r ^2s = .59–.83).

CONCLUSION. The aEFPT tasks are comparable to the original EFPT tasks, providing occupational therapy practitioners with additional tasks that can be used clinically to identify performance-based executive function deficits in people with stroke.

In light of the Centennial Vision charge of supporting practice through evidence, this article reviews productive aging research published in the American Journal of Occupational Therapy (AJOT) in 2013 and as a whole from 2009 to 2013. Thirteen such articles were published in 2013, consisting of 4 systematic reviews that identified effective occupational therapy interventions for older adults with low vision; 1 randomized controlled trial that examined changes in occupational therapists’ mental health practices with DVD training; and 8 descriptive articles addressing instrument development, practitioner decision making, patient management of medications, and effects of task activities on pain and participation levels. From 2009 to 2013, the quantity and quality of AJOT articles on productive aging increased; 63 articles were published, including 24 effectiveness studies, 14 basic research studies, 15 articles on instrument development and testing, 1 article linking occupational engagement and health, 6 articles on professional education, and 3 articles addressing professional questions.