American Journal of Occupational Therapy

As our health care system continues to change, so do the opportunities for occupational therapy. This article provides an update to a 2012 Health Policy Perspectives on this topic. We identify new initiatives and opportunities in primary care, explore common challenges to integrating occupational therapy in primary care environments, and highlight international works that can support our efforts. We conclude by discussing next steps for occupational therapy practitioners in order to continue to progress our efforts in primary care.

Challenges with handwriting can have a negative impact on academic performance, and these challenges are commonly addressed by occupational therapy practitioners in school settings. This systematic review examined the efficacy of curriculum-based interventions to address children’s handwriting difficulties in the classroom (preschool to second grade). We reviewed and computed effect sizes for 13 studies (11 Level II, 2 Level III) identified through a comprehensive database search. The evidence shows that curriculum-based handwriting interventions resulted in small- to medium-sized improvements in legibility, a commonly reported challenge in this age group. The evidence for whether these interventions improved speed is mixed, and the evidence for whether they improved fluency is insufficient. No clear support was found for one handwriting program over another. These results suggest that curriculum-based interventions can lead to improvements in handwriting legibility, but Level I research is needed to validate the efficacy of these curricula.

OBJECTIVE. We investigated factors that influenced occupational therapists’ beliefs about and use of sensory-based approaches for children with autism spectrum disorder (ASD).

METHOD. Occupational therapists working with children with ASD (N = 211 from 16 countries) completed an online survey addressing their work experience, training, use of sensory-based approaches, and beliefs and perceptions about the effects of the approaches. Linear regression was used to determine predictors of use of and beliefs about sensory-based approaches.

RESULTS. Most respondents (98%) used sensory-based approaches for children with ASD and would recommend the approaches for 57% of the children they treated. Having a mentor who promoted sensory-based approaches and practicing outside North America and Australia predicted greater use and perceived effectiveness of these approaches. Less than 5 yr of occupational therapy experience predicted less use of the approaches.

CONCLUSION. Respondents selectively used sensory-based approaches for children with ASD and were influenced by country of residence, clinical experience, and mentorship.

A mixed-methods design was used to explore the outcomes of a 6-wk, occupational therapist–led Comfortable Cafeteria program designed to build cafeteria supervisors’ and students’ capacity to create a positive mealtime environment so that all students can successfully participate in and enjoy a healthy meal and socialization with peers. Students whose scores were in the low and mid-range at the outset had statistically significant improvements in pretest–posttest visual analog scale ratings of participation and enjoyment. Cafeteria supervisors demonstrated statistically significant improvements in their perceptions of knowledge and skills to supervise and to encourage healthy eating. Qualitative findings add further insight into the program, suggesting that students learned prosocial values (e.g., being kind, helping others), supervisors actively encouraged positive social interaction, and occupational therapists enjoyed implementing the program and recognized positive supervisor and student changes as a result of integrating services in the cafeteria.

OBJECTIVE. The purpose of this study was to understand the age-related changes, adaptations, and contexts that support older workers in the manufacturing sector.

METHOD. In a multiple-case study, 10 older workers from two manufacturing companies completed the Job Content Questionnaire, Health and Productivity Questionnaire, and semistructured interviews and underwent task observations for 8 hr over 4 mo.

RESULTS. Age-related changes affecting job tasks included near vision, upper extremity strength, grip strength, joint stiffness, and endurance. Older workers adapted job tasks by changing their work style, using equipment available, and relying on close coworkers for assistance. They adapted their personal lifestyle to maintain the energy necessary to meet job demands. Organizational contexts that supported older workers highlighted job control, social support, and mutual respect.

CONCLUSION. This study suggests that occupational therapy practitioners can provide individualized adaptations, environmental modifications, and health promotion strategies to help older workers meet job demands while balancing work and home occupations.

Using a phenomenological approach, this study investigated visibility and perception of the profession of occupational therapy in three media outlets. Content analysis occurred on LexisNexis Academic (LNA), Google Images, and Twitter platforms. Analysis of LNA identified the prevalence of articles about occupational therapy in domestic newspapers and similar media avenues, MaxQDA qualitative software coded Google Images from a search on occupational therapy, and AnalyzeWords evaluated Twitter feeds of four health care professions for presence and tone in a social media context. Results indicate that although occupational therapy is 100 years old, its presence in news and online platforms could be stronger. This study suggests that a clear professional identity for occupational therapy practitioners must be strategically communicated through academic and social platforms. Such advocacy promotes the profession, meets the next iteration of occupational therapy’s professional vision, and allows occupational therapy to remain a prominent and formidable stakeholder in today’s health care marketplace.

OBJECTIVE. The purpose of this study was to investigate the gender differences in psychosocial and physical outcomes in users of lower-extremity prostheses who became amputees after the 2010 earthquake in Haiti.

METHOD. We enrolled 140 unilateral amputees in this cross-sectional study in Port-au-Prince, Haiti. Trained staff administered the assessments by reading the questions aloud to participants. Participants completed the Trinity Amputation and Prosthesis Experience Scales and Locomotor Capabilities Index about 2 yr after the earthquake.

RESULTS. We found no gender differences in psychosocial adjustment and physical outcomes, except for strenuous physical activities and phantom pain, and both genders reported difficulty in social adjustment. After controlling for strenuous physical activities and phantom pain, we found that men showed worse psychosocial adjustment than women.

CONCLUSION. Services for psychosocial adjustment are critical for traumatic amputees and should be incorporated into rehabilitation programs after a disaster. Interventions should consider gender roles in the indigenous culture.

OBJECTIVE. Our objective was to determine the effect of loss of body sensation on activity participation in stroke survivors.

METHOD. Participants (N = 268) were assessed at hospital admission for somatosensory and motor impairment using the National Institutes of Health Stroke Scale. Participation was assessed using the Activity Card Sort (ACS) in the postacute phase. Between-group differences in activity participation were analyzed for participants with and without somatosensory impairment and with or without paresis.

RESULTS. Somatosensory impairment was experienced in 33.6% of the sample and paresis in 42.9%. ACS profiles were obtained at a median of 222 days poststroke. Somatosensory loss alone (z = 1.96, p = .048) and paresis in upper and lower limbs without sensory loss (z = 4.62, p < .001) influenced activity participation.

CONCLUSION. Somatosensory impairment is associated with reduced activity participation; however, paresis of upper and lower limbs can mask the contribution of sensory loss.

OBJECTIVE. Proximal humerus fractures are highly traumatic and debilitating. Surgical fixation may be contraindicated in older clients, thus requiring a systematic rehabilitation protocol. These clients may suffer loss of independence and require long-term assistance if not treated properly.

METHOD. In this case report, we describe the occupation-based conservative rehabilitation of a retired male client after a four-part proximal humerus fracture. Outcome measurements used were the QuickDASH, the Numeric Rating Scale for Pain, goniometric measurements, and manual muscle testing. Repeated measures were used to collect data throughout a 12-mo period.

RESULTS. Scores and measurements demonstrated improvement in all four outcome measures with clinically notable improvements achieved and maintained throughout the 12-mo period. The client reported a full return to activity.

CONCLUSION. The techniques presented can be used by clinicians to create treatment plans, achievable functional goals, and realistic expectations for their clients. The protocol can aid clinicians in achieving objective milestones through occupation-based interventions.

OBJECTIVE. Neurological bilateral upper limb weakness can result in self-feeding difficulties and reliance on care providers. Mealtimes become time consuming and frustrating. In this exploratory inquiry, we examined the experiences of users of a feeding device.

METHOD. Semistructured interviews were either conducted by telephone or administered via email to explore quality of life, changes to independence, benefits and limitations, and psychological impact of the equipment.

RESULTS. Thematic analysis gave rise to five themes: independence and positivity, emotions, impact on family and social life, equipment functionality, and motivation.

CONCLUSION. This exploratory inquiry has contributed new qualitative evidence to the knowledge and understanding of users’ experiences of a manual feeding device. Users reported that the need for assistance was reduced and that their quality of life, independence, and freedom improved. Time and resources savings for the family, care providers, and staff appeared to result in a more equal relationship between user and care provider.

OBJECTIVE. We evaluated the feasibility of an intervention combining metacognitive strategy instruction (MSI) with training in implementation intentions for adults with mild traumatic brain injury (mTBI). Implementation intentions are written premade decision statements specifying when, where, and how goal behaviors are to be enacted.

METHOD. Two participants with mTBI received a six-session intervention that included setting a daily implementation intention for an occupational therapy goal. A scoring rubric was used to evaluate the quality of implementation intentions; goal achievement was measured using the Canadian Occupational Performance Measure (COPM) and goal attainment scaling.

RESULTS. All implementation intentions received perfect quality scores, suggesting participants learned to correctly craft implementation intentions. Improvements in COPM self-ratings exceeded minimal detectable change values; goal attainment levels indicated better-than-expected goal achievement.

CONCLUSION. An intervention combining MSI and implementation intention training appears to be feasible. As an adjunct to MSI, implementation intentions may contribute to clients’ ability to achieve their own occupational performance goals. Further study is needed.

Feeding interventions that support family relationships enhance children’s daily participation in meaningful occupations at home. A critical review of the literature yielded several premises that support the development of a relationship-based feeding framework. The proposed theoretical framework, based on the Biopsychosocial Model of Pediatric Feeding (Berlin, Davies, Lobato, & Silverman, 2009) and the Ecological Model of Occupation (Dunn, Brown, & Youngstrom, 2003), is presented to guide feeding interventions for children with significant feeding difficulties. A case example that illustrates the practical application of this framework is provided. Further development of relationship-based feeding theory and research is recommended to improve the occupational performance and quality-of-life outcomes for children and their families.