American Journal of Occupational Therapy

As the health care system continues to evolve toward one based on quality not quantity, demonstrating the value of occupational therapy has never been more important. Providing high-quality services, achieving optimal outcomes, and identifying and promoting occupational therapy’s distinct value are the responsibilities of all practitioners. In relation to the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, the Centers for Medicare and Medicaid Services (CMS) is implementing new functional items and related outcome performance measures across postacute care (PAC) settings. Practitioners can demonstrate the role and value of occupational therapy services through their participation in data collection and the interpretation of the resulting performance measures. In this column, we review the objectives of the IMPACT Act, introduce the new self-care and mobility items and outcome performance measures being implemented in PAC settings, and describe ways to use these new data to advocate for occupational therapy. We also discuss American Occupational Therapy Association initiatives to provide materials and guidance for occupational therapy practitioners to contribute to PAC data collection.

OBJECTIVE. The aim of this study was to conduct a broad in-depth examination of the relationship between developmental coordination disorder (DCD) and use of executive strategies, daily life activities, emotional state, and internal factors attributed to success.

METHOD. We used a large randomized cohort of young adults. Structural equation modeling was performed to test both the direct effects and the mediated effects of the independent variable (probable DCD) on dependent variables (executive functions, academic and nonacademic activities, emotional state, and attribution to success).

RESULTS. Probable DCD had a direct and significant effect on all variables. Motor coordination impairments directly affected daily function in nonacademic and academic abilities and resulted in decreased use of executive strategies. Likewise, all the indirect effects hypothesized in the model were found to be significant.

CONCLUSION. The model revealed the direct and indirect influences of probable DCD on a range of functions, with far-reaching clinical implications.

OBJECTIVE. We investigated the efficacy of Occupation-Based Coaching delivered via telehealth for families of young children with autism spectrum disorder (ASD).

METHOD. Participants were 18 families of children with ASD ages 2–6 yr. We used descriptive statistics to understand intervention characteristics and paired-sample t tests to examine changes in parent efficacy and child participation.

RESULTS. Parents identified many areas of child adaptive behavior as intervention goals. Results showed that parent efficacy and various domains of child participation significantly increased postintervention (both ps < .05). Additionally, children showed significant gains in parent-identified goals.

CONCLUSION. Occupation-Based Coaching delivered via telehealth appears to be an effective method of intervention to increase parent efficacy and child participation among families of children with ASD. Occupational therapists may consider how telehealth may be used to provide intervention to an increased number of families, in particular those in underserved areas.

OBJECTIVE. The aim of this scoping review was to describe the characteristics and features of substance abuse interventions for women in North America and discuss the findings from an occupational perspective.

METHOD. A scoping review was conducted to examine North American peer-reviewed literature published between 2001 and 2014. Four databases were searched using terms related to intervention, substance abuse, and women only. Descriptive statistics of categorical groupings were used to describe the data sources and characteristics and features of the interventions.

RESULTS. Forty-two articles met the inclusion criteria, with the majority citing a harm-reduction approach and using multifaceted interventions with various targets for change.

CONCLUSION. Substance abuse interventions for women are typically multifaceted and follow a harm-reduction philosophy. Further research into the efficacy of interventions that more specifically target occupation beyond substance use is needed.

OBJECTIVE. We evaluated the impact of a 1-wk activity program on the health, quality of life (QOL), and occupational performance of community-living women diagnosed with cancer.

METHOD. A one-group pretest–posttest repeated-measures design was used. Participants completed a functional health measure (36-Item Short Form Health Survey [SF–36]), a QOL measure (World Health Organization Quality of Life–Brief version [WHOQOL–BREF]), and an occupational performance and satisfaction measure (Canadian Occupational Performance Measure [COPM]) before and 6 wk after program completion. The COPM was also administered on Day 5.

RESULTS. Paired t tests for the SF–36 and WHOQOL–BREF showed no significant differences, except for the WHOQOL–BREF’s Social Relationships subscale (p < .008). Repeated-measures analyses of variance showed a significant difference in COPM performance and satisfaction scores (p < .001).

CONCLUSION. The activity program effectively improved occupational performance and satisfaction and social relationships of community-living women diagnosed with cancer.

OBJECTIVE. This article describes the cost of occupational therapy by provider, insurance status, and geographic region and the number of visits allowed and out-of-pocket costs under proposed therapy caps.

METHOD. This retrospective, population-based study used Medicare Provider Utilization and Payment Data for occupational therapists billing in 2012 and 2013 (Ns = 3,662 and 3,820, respectively). We examined variations in outpatient occupational therapy services with descriptive statistics and the impact of therapy caps on occupational therapy visits and patient out-of-pocket costs.

RESULTS. Differences in cost between occupational and physical therapists were minimal. The most frequently billed service was therapeutic exercises. Wisconsin had the most inflated outpatient costs in both years. Under the proposed therapy cap, patients could receive an evaluation plus 12–14 visits.

DISCUSSION. Wide variation exists in potential patient out-of-pocket costs for occupational therapy services on the basis of insurance coverage and state. Patients without insurance pay a premium.

OBJECTIVE. The Executive Function Performance Test (EFPT) is a reliable and valid performance-based tool to assess executive functions (EFs). This study’s objective was to develop and verify two Internet-based tasks for the EFPT.

METHOD. A cross-sectional study assessed the alternate-form reliability of the Internet-based bill-paying and telephone-use tasks in healthy adults and people with subacute stroke (Study 1). It also sought to establish the tasks’ criterion reliability for assessing EF deficits by correlating performance with that on the Trail Making Test in five groups: healthy young adults, healthy older adults, people with subacute stroke, people with chronic stroke, and young adults with attention deficit hyperactivity disorder (Study 2).

RESULTS. The alternative-form reliability and initial construct validity for the Internet-based bill-paying task were verified. Criterion validity was established for both tasks.

CONCLUSION. The Internet-based tasks are comparable to the original EFPT tasks and can be used for assessment of EF deficits.

OBJECTIVE. The overall aim of this study is to create an item pool reflecting the cognitive concerns expressed by people with HIV as a first step toward developing such a measure.

METHOD. Semiqualitative interviews with 292 people with HIV were carried out. Their concerns were mapped to neurocognitive domains to identify concern content areas and were compared with existing cognitive questionnaires. A questionnaire was developed to estimate the prevalence and importance of the items.

RESULTS. Sixty of 125 items were retained in the questionnaire based on ratings of their prevalence, importance, and clarity. Memory and behavioral and emotional concerns were the most common content areas (15 each); other domains were attention (7), executive function (6), language (5), and cognitive change (12).

CONCLUSION. People living with HIV experience difficulties in all domains of cognition. By recognizing all domains, this new measure can help clinicians better understand areas of perceived cognitive difficulty and plan interventions accordingly.

OBJECTIVE. This study investigates the effect of mirror therapy and task-oriented training on the paretic upper extremity function and occupational performance of people with stroke.

METHOD. This study used a repeated-measures, case-series design in which 4 participants completed a 4-wk intervention consisting of mirror therapy and task-specific training. The intervention was conducted 2×/wk in the clinic and 4×/wk at home.

RESULTS. All participants displayed clinically meaningful improvements in self-identified goals at the end of the intervention and at follow-up. Three participants showed clinically meaningful changes in motor function. Although only 1 participant improved in his reported amount of use, all participants showed clinically meaningful improvements in perceived movement quality at varying points of assessment.

CONCLUSION. Mirror therapy, when used as priming for task-oriented training, can produce clinical improvements in upper extremity function and occupational performance in people with hemiparesis.

OBJECTIVE. We aimed to corroborate the effectiveness of the Collaborative Consultation for Participation of Students With Intellectual Disability (Co-PID), intended for enhancing participation in classroom-related activities.

METHOD. The study took place in two special education schools and included students with moderate intellectual and developmental disabilities ages 7–20 yr. The schools were randomly assigned to intervention (Co-PID; n = 28 students, n = 4 teachers) and control (In-Service [IS]; n = 32 students, n = 7 teachers) groups. Participation was evaluated at pre- and posttest of an 8-mo intervention.

RESULTS. The Co-PID improved students’ ability to choose among provided options. Additionally, the Co-PID group achieved more goals (measured by goal attainment scaling) than the IS group in all participation areas, and their enhanced participation transferred to other school environments (as measured by the School Function Assessment).

CONCLUSION. The Co-PID was found to be an effective program for enhancing classroom and school participation.

OBJECTIVE. In this pilot study of a home-based occupational therapy intervention intended to reduce disability and improve quality of life, our objective was to identify rates of goal attainment and patterns of goal adjustment of participants.

METHOD. Thirty older adults with cancer were randomized to the intervention arm, and 24 participants identified goals and completed the six-session intervention. An exploratory content analysis of qualitative and quantitative session data was performed.

RESULTS. Participants set 63 6-wk goals and attained 62% of them. Most of the goals addressed walking (28%), sedentary leisure (24%), exercising (16%), or instrumental activities of daily living (14%). When 6-wk goals were not attained (n = 24), there were 10 instances of goal disengagement and 14 instances of goal reengagement.

CONCLUSION. Although most participants were able to meet their goals, many also changed their goals and priorities after reflection and attempts to resume or initiate meaningful activities.

OBJECTIVE. Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers are the largest provider of long-term services and supports for people with intellectual and developmental disabilities (IDDs). In this study, we explored how HCBS IDD waivers projected providing occupational therapy services in Fiscal Year (FY) 2015.

METHOD. Medicaid HCBS IDD waivers across the nation gathered from the Centers for Medicare and Medicaid Services were qualitatively and quantitatively analyzed to determine how they projected providing occupational therapy services in terms of service expenditures and utilization.

RESULTS. In FY 2015, $14.13 million of spending was projected for occupational therapy services of 7,500 participants. However, there was large heterogeneity across states and services in terms of total projected spending, spending per participant, and reimbursement rates.

CONCLUSION. Comparisons across states strengthen the profession’s ability to assert the value of its services. These findings can help identify best practices and can advocate for the refinement of state occupational therapy programs.

OBJECTIVE. The objective of this article was to explore the effects of enhanced lighting on the function of people with an acquired visual deficit resulting from cerebrovascular accident (CVA) in an inpatient rehabilitation facility (IRF).

METHOD. An ABAB design was used with two cases to assess how a short-term intervention involving lighting changes affected clients’ grooming performance in an IRF. Analysis consisted of scores on the grooming section of the FIM^®, times for each grooming task, and light meter readings.

RESULTS. Both participants demonstrated improvements in function as measured by the FIM and in time to complete grooming tasks with enhanced lighting.

CONCLUSION. These results suggest that individualized lighting can lead to improved grooming function in clients with CVA.

Patients with Duchenne muscular dystrophy in their second decade of life present with decreased upper extremity strength and active range of motion (AROM) that limit activities of daily living (ADLs). We evaluated the ability of the Wilmington Robotic Exoskeleton (WREX) to improve AROM and independence with ADLs. A retrospective chart review of 9 patients who trialed the WREX was performed. Patients were classified on the basis of the Brooke Upper Extremity Scale. AROM, strength, and independence with ADLs were assessed before and after a WREX trial. Patients demonstrated increased shoulder flexion and abduction (25°–100°, median = 55°) and elbow flexion (10°–110°, median = 60°). Increased independence with self-feeding, item retrieval, use of phones and tablets, and facial grooming were noted. The WREX allowed for gravity-reduced movement via elastic bands to unweight the upper extremity, enabling increased upper extremity active movement that supported increased independence with ADLs.

OBJECTIVE. We sought to determine under what conditions brighter lighting improves reading performance.

METHOD. Thirteen participants with typical sight and 9 participants with age-related macular degeneration (AMD) read sentences ranging from 0.0 to 1.3 logMAR under luminance levels ranging from 3.5 to 696 cd/m².

RESULTS. At the dimmest luminance level (3.5 cd/m²), reading speeds were slowest at the smaller letter sizes and reached an asymptote for larger sizes. When luminance was increased to 30 cd/m², reading speed increased only for the smaller letter sizes. Additional lighting did not increase reading speeds for any letter size. Similar size-related effects of luminance were observed in participants with AMD.

CONCLUSION. In some instances, performance on acuity-limited tasks might be improved by brighter lighting. However, brighter lighting does not always improve reading; the magnitude of the effect depends on the text size and the relative changes in light level.

OBJECTIVE. We investigated the effect of a combined neuromuscular electrical stimulation (ES) and dynamic hand orthosis (DHO) regimen with a group of people with chronic stroke to improve performance on specific daily tasks.

METHOD. Four people with chronic stroke participated in an ES–DHO regimen using the affected upper extremity 5×/wk for 6 wk. Outcome measures included grip strength, range of motion (ROM), and analysis of muscle activation–deactivation during release of grasp through electromyography. Ability to perform specific daily living tasks was assessed using the Assessment of Motor and Process Skills (AMPS).

RESULTS. Results suggested that improvements in strength, ROM, and grasp deactivation are possible with the combined ES–DHO regimen. All participants’ AMPS motor scores improved.

CONCLUSIONS. An ES–DHO regimen may improve motor skills needed for functional task performance in people with chronic stroke. Results should be interpreted cautiously because of the pilot nature of the study and the small sample size.

OBJECTIVE. We investigated the feasibility and acceptability of an occupational therapy intervention targeting diabetes management for underserved young adults.

METHOD. Eight participants completed the intervention and a battery of assessments at baseline and after the intervention. At completion, the participants and occupational therapist were interviewed about their experiences with the study. Four categories of assessment questions were used to guide the study: process, resource, management, and scientific.

RESULTS. Successes included recruitment; fulfillment of tasks by staff and partnering clinics; adequate space, financial support, and equipment; and meaningfulness of the intervention for participants. Challenges included scheduling participants for the intervention and follow-up focus groups and providing client centeredness and flexibility while reducing burden on the intervener.

CONCLUSION. This feasibility study allowed us to make necessary revisions to our study protocol before implementing a larger pilot study.

The American Occupational Therapy Association (AOTA) Evidence-Based Practice Project has developed a table summarizing the research opportunities for adults with Alzheimer’s disease and related major neurocognitive disorders. 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 Practice Guidelines Series. Researchers, clinicians, and students can use this information in developing innovative research to answer important questions within the occupational therapy field.