American Journal of Occupational Therapy

The American Journal of Occupational Therapy (AJOT) had a successful 2015. From September 2014 to September 2015, the number of manuscripts submitted had increased by 35%. Manuscripts were received from 23 countries, compared with 17 countries in 2014. AJOT continues to have the highest impact factor and to be the highest ranked of the occupational therapy journals listed in Journal Citation Reports. AJOT continues to focus on publishing research articles on aspects of occupational therapy among varied populations with diverse acute and chronic conditions. Additional changes for 2015 include new associate editors, a significantly enlarged pool of reviewers from across the globe, continuous publishing, pay-per-view, updated author guidelines, and the adoption of clinical trial registration requirements effective January 1, 2016.

Engagement, exploration, and empowerment are significant practice strategies used by occupational therapy practitioners as a means of getting to know what matters to clients and how to facilitate their participation in everyday life. Applied to the American Occupational Therapy Association (AOTA) as an organization, professional engagement, exploration of new service contexts, and empowerment of members to take an active role in shaping the profession's future are examined. This address, given at the 2015 AOTA Annual Convention & Expo, looks to the future in terms of engaging greater numbers of members; participating in Vision 2025, a strategic planning initiative that will be unveiled at the 2016 AOTA Annual Conference & Expo; and empowering members to achieve excellence in occupational therapy.

This article, based on the 52nd Eleanor Clarke Slagle lecture given at the 95th American Occupational Therapy Association Annual Conference & Expo, explores the concept of inquiry as the basis for a career and as an activity of daily living. Using the heliocentric theory and the space program at NASA as examples, the broad concept of inquiry is discussed, because it has led to important changes in society over the course of history. The article describes how a career as a clinician–scientist can be grounded in the concept of inquiry and explains how all occupational therapists and occupational therapy assistants can base their own careers in inquiry, using examples from the early history of the profession of occupational therapy and from work by current investigators. Practical suggestions applicable to every clinician are provided.

Pediatric constraint-induced movement therapy (pCIMT) is one of the most efficacious treatments for children with cerebral palsy (CP). Distinctive components of pCIMT include constraint of the less impaired upper extremity (UE), high-intensity therapy for the more impaired UE (≥3 hr/day, many days per week, for multiple weeks), use of shaping techniques combined with repetitive task practice, and bimanual transfer. A critical issue is whether multiple treatments of pCIMT produce additional benefit. In a clinical cohort (mean age = 31 mo) of 28 children with asymmetrical CP whose parents sought multiple pCIMT treatments, the children gained a mean of 13.2 (standard deviation [SD] = 4.2) new functional skills after Treatment 1; Treatment 2 produced a mean of 7.3 (SD = 4.7) new skills; and Treatment 3, 6.5 (SD = 4.2). These findings support the conclusion that multiple pCIMT treatments can produce clinically important functional gains for children with hemiparetic CP.

OBJECTIVE. We sought to determine occupational therapists’ opinions of two pediatric constraint-induced movement therapy (pCIMT) protocols.

METHOD. A total of 272 therapists in pediatric rehabilitation clinics completed an electronic survey to determine their opinions of two published pCIMT protocols. In Protocol A, restraint is worn 24 hr/day on the nonparetic upper extremity (UE), and in-clinic, therapist-supervised practice sessions occur 7 days/wk for 6 hr/day over 3 wk. In Protocol B, restraint is worn 2 hr/day on the nonparetic UE, and in-clinic, therapist-supervised practice sessions occur 1 day/wk for 2 hr/day over 8 wk.

RESULTS. The majority of participants reported moderate to high concerns about every facet of Protocol A. Conversely, >50% of participants reported low or no concerns about five of seven facets of Protocol B.

CONCLUSION. This study adds to a growing body of evidence suggesting that therapists strongly prefer low-duration pCIMT protocols.

Selective eating is common in children with autism spectrum disorder (ASD), but it is not yet well understood. The objectives of this study were to examine a new definition of selective eating, compare behavioral measures between children with ASD and selective eating and those without selective eating, and determine relationships among behavioral measures and measures of selective eating. Participants were assigned to groups on the basis of number of foods eaten compared with a population-based sample. Results of one-way multivariate analysis of variance indicated no overall effect of group for challenging behaviors, sensory reactivity, or repetitive behaviors. Between-participant tests indicated that scores for compulsive behaviors were significantly lower (p = .036) for the selective eating group. Correlations were moderately strong among variables relating to food intake and behavioral variables, but were not significant between selective eating and behavioral variables. Further research is needed to validate the definition of selective eating and to identify targets for intervention.

OBJECTIVE. Anxiety disorders are the most prevalent psychological disorders among children and youths. There is growing interest in intervention options for anxiety. Yoga is widely used in clinical, school, and community settings, but consolidated sources outlining its effectiveness in reducing anxiety are limited.

METHOD. This systematic review examined the evidence base (1990–2014) for yoga interventions addressing anxiety among children and adolescents (ages 3–18 yr).

RESULTS. We identified 2,147 references and found 80 articles that were eligible for full-text review. The final analysis included 16: 6 randomized controlled trials, 2 nonrandomized preintervention–postintervention control-group designs, 7 uncontrolled preintervention–postintervention studies, and 1 case study.

CONCLUSION. Nearly all studies indicated reduced anxiety after a yoga intervention. However, because of the wide variety of study populations, limitations in some study designs, and variable outcome measures, further research is needed to enhance the ability to generalize and apply yoga to reduce anxiety.

OBJECTIVE. The objective of this study was to determine the psychometric properties of the Vocational Fit Assessment (VFA) by examining its factor structure and subscale reliability.

METHOD. This prospective cross-sectional study used two surveys (one for worker abilities and one for job demands) to collect the data needed for the psychometric evaluation of the VFA. Latent parallel analysis and ordinal exploratory factor analysis were used to iteratively refine VFA subscales.

RESULTS. Ten unidimensional subscales emerged from factor analysis of VFA items: (1) Cognitive Abilities, (2) Communication Skills, (3) Computer Skills, (4) Higher Task-Related Abilities, (5) Interpersonal Skills, (6) Lower Task-Related Abilities, (7) Physical Abilities, (8) Safety, (9) Self-Determination, and (10) Work Structure. Subscale internal consistency (ordinal α) was ≥.86 for VFA for worker abilities and ≥.77 for VFA for job demands.

CONCLUSION. The unidimensional structure of VFA subscales and estimates of internal consistency lend initial evidence in support of their reliability and validity.

The Classroom Sensory Environment Assessment (CSEA) is a tool that provides a means of understanding the impact of a classroom’s sensory environment on student behavior. The purpose of the CSEA is to promote collaboration between occupational therapists and elementary education teachers. In particular, students with autism spectrum disorder included in general education classrooms may benefit from a suitable match created through this collaborative process between the sensory environment and their unique sensory preferences. The development of the CSEA has occurred in multiple stages over 2 yr. This article reports on descriptive results for 152 classrooms and initial reliability results. Descriptive information suggests that classrooms are environments with an enormous variety of sensory experiences that can be quantified. Visual experiences are most frequent. The tool has adequate internal consistency but requires further investigation of interrater reliability and validity.

OBJECTIVE. This study explores the effectiveness of the Handwriting Without Tears^® (HWT) kindergarten printing curriculum in general education through a consultative approach with occupational therapy.

METHOD. One cohort of students was the control (n = 19), whereas two other cohorts were experimental groups learning printing through the HWT curriculum (n = 20 each). The Test of Handwriting Skills–Revised (THS–R) was used to collect end-of-year legibility scores for all cohorts.

RESULTS. Both experimental groups individually and both experimental groups combined into one group outperformed the control group on all 10 of the THS–R subtests—scoring significantly higher (p < .05 using analysis of covariance controlling for age and gender) on 6 of the subtests for the former and 7 for the latter—and on overall score. Large treatment effects were found for the standard score for each experimental group (d = 0.81, 1.03, and 1.00).

CONCLUSION. This study supports the consultative role of occupational therapy with teachers in general education for handwriting curriculum implementation and the success of HWT for printing instruction.

PURPOSE. We explored the meaning and outcomes of a 6-mo building capacity process designed to promote knowledge translation of a public health approach to mental health among pediatric occupational therapy practitioners participating in a Community of Practice.

METHOD. A one-group (N = 117) mixed-methods design using a pretest–posttest survey and qualitative analysis of written reflections was used to explore the meaning and outcomes of the building capacity process.

RESULTS. Statistically significant improvements (p < .02) in pretest–posttest scores of knowledge, beliefs, and actions related to a public health approach to mental health were found. Qualitative findings suggest that participation resulted in a renewed commitment to addressing children’s mental health.

CONCLUSION. The building capacity process expanded practitioner knowledge, renewed energy, and promoted confidence, resulting in change leaders empowered to articulate, advocate for, and implement practice changes reflecting occupational therapy’s role in addressing children’s mental health.

Latino adults between ages 50 and 60 yr are at high risk for developing chronic conditions that can lead to early disability. We conducted a qualitative pilot study with 11 Latinos in this demographic group to develop a foundational schema for the design of health promotion programs that could be implemented by occupational therapy practitioners in primary care settings for this population. One-on-one interviews addressing routines and activities, health management, and health care utilization were conducted, audiotaped, and transcribed. Results of a content analysis of the qualitative data revealed the following six domains of most concern: Weight Management; Disease Management; Mental Health and Well-Being; Personal Finances; Family, Friends, and Community; and Stress Management. A typology of perceived health-actualizing strategies was derived for each domain. This schema can be used by occupational therapy practitioners to inform the development of health-promotion lifestyle interventions designed specifically for late-middle-aged Latinos.

OBJECTIVE. Engaging in food activities and maintaining identity are each important for productive aging. This study explored the role of food activities in identity maintenance among community-living older adults.

METHOD. We used a grounded theory approach to analyze data collected in semistructured interviews with 39 predominantly White, British older adults living in West London.

RESULTS. Two lifelong food identities—“food lover” and “nonfoodie”—were maintained in the processes of participation and maintenance and threat and compensation. The process change in meaning and identity explained the development of a third food identity—“not bothered”—when participants experienced being alone at the table, deteriorating health, and worry about the cost of food.

CONCLUSION. Food activities that are a pleasurable and important part of daily life contribute to the maintenance of important identities and mental well-being in older adults.

This study aimed to explore functional deficits and perceived quality of life (QoL) among cancer survivors. Sixty-six participants completed the Post Cancer Outcome Survey developed for the purpose of this study. The results indicated (1) modest to moderate degrees of functional deficits in 28 of the 70 items measuring areas of occupation, performance skills, body functions, and psychosocial well-being within the first year after cancer treatment; (2) significantly lower perceived QoL during the first year of survivorship compared with that before diagnosis, at present, and 5 yr hereafter (p < .001); (3) significant moderate negative correlations between the reported functional deficits and QoL (r _s = –.45 to –.57); and (4) a very low percentage of participants (4.5%) receiving occupational therapy during the first year posttreatment. Functional difficulties and compromised QoL identified in this study indicate the need for occupational therapy among cancer survivors. Increasing clients’ awareness of occupational therapy for postcancer care is also suggested.

OBJECTIVE. The Functional Upper Extremity Levels (FUEL) is a new classification tool to assess a person’s upper-extremity functional and physical performance after sustaining a stroke. The aim of this preliminary study was to develop the tool and determine its content validity and interrater reliability.

METHOD. Forty-four licensed occupational therapists ranging in years of experience from 6 mo to 16 yr participated in this study. A two-phase study was conducted: (1) constructing the FUEL and determining its content validity and (2) ascertaining its interrater reliability.

RESULTS. We found that the FUEL had initial content validity and substantial interrater reliability (Fleiss κ = .754).

CONCLUSION. The FUEL can be a useful clinical and research tool in occupational therapy for the assessment and classification of upper-extremity function for people after stroke. Further studies with larger samples and comparison studies with other similar tools are required to support the tool’s reliability and validity.

OBJECTIVE. The objective of this study was to examine the effectiveness of delivering Managing Fatigue: A Six-Week Course for Energy Conservation via telehealth for a 70-yr-old man with poststroke fatigue (PSF).

METHOD. For this pilot case study, a questionnaire developed by the authors and the Patient-Reported Outcomes Measurement Information System Fatigue Short Form 7a were used for screening. The study was implemented via teleconference over an 8-wk period. The Fatigue Impact Scale (FIS) and the Canadian Occupational Performance Measure (COPM) were used to gather pretest and posttest data.

RESULTS. After the participant completed the course, decreased fatigue impact was noted on the FIS, and modestly improved occupational performance and satisfaction were evidenced by the COPM.

CONCLUSION. For this single participant experiencing PSF, performance and satisfaction on the COPM guardedly improved and fatigue impact decreased after participation in the energy conservation course offered by teleconference, a form of telehealth delivery. Further research is recommended with larger sample sizes.

This article builds on the work of Case-Smith and colleagues and proposes a roadmap to guide future research in occupational therapy. To foster best practice in the application of principles and practices of sensory integration (SI), the pillars of practice, advocacy, and education are identified as elements that provide the foundation for research. Each pillar ensures that SI research is conducted in a rigorous and relevant manner. To this end, achievements to date are discussed, with proposed goals presented for each pillar. Finally, the roadmap builds on the pillars and outlines implications for occupational therapy with the overarching theme that a wide array of scientists, educators, therapists, and service recipients will be needed to ensure that those who may benefit most have access to intervention that is evidence based, theory driven, and provided within the highest standards of service delivery.