American Journal of Occupational Therapy

OBJECTIVE. The purpose of this systematic review was to evaluate the evidence for the effectiveness of parent-mediated interventions on occupational performance of children with autism spectrum disorder (ASD).

METHOD. We conducted a search of academic databases using terms such as autism spectrum disorder, parent, caregiver, and intervention. Five hundred eighty-two articles were reviewed, and 109 were selected for full-text review. The final analysis included 13 articles.

RESULTS. Strong evidence was found for the efficacy of parent-mediated intervention for increasing child joint attention. Moderate evidence was found for the improvement of language scores, expressive language, nonverbal communication, initiation and response to interaction, behavior, play, adaptive functioning, ASD symptoms, and social communication.

CONCLUSION. This systematic review suggests that parent-mediated interventions for children with ASD can improve various aspects of communication and ASD symptoms, with emerging support for occupational performance. Occupational therapy practitioners are well suited to facilitate these interventions to support families with children with autism.

Importance: The Occupational Self-Assessment, Version 2.2 (OSA 2.2), is a client-centered measure of clients’ perceived occupational competence and value. The OSA 2.2 has previously demonstrated good structural validity and internal consistency; however, the administration length could deter therapists from using this assessment in acute care and acute inpatient rehabilitation.

Objective: To evaluate reliability and validity of the OSA 2.2 in acute care and acute inpatient rehabilitation and to develop and validate the OSA–Short Form (OSA–SF).

Design: We performed a descriptive psychometric analysis using the Rasch analytic approach.

Setting: The data were collected in acute care and acute inpatient rehabilitation.

Participants: Our convenience sample consisted of 86 patients in acute care and acute inpatient rehabilitation.

Outcomes and Measures: Participants rated their perceived occupational competence and value by completing the OSA 2.2.

Results: We examined psychometric properties of the OSA 2.2 and OSA–SF using a partial credit Rasch model. The 21-item OSA 2.2 was reduced to a 12-item OSA–SF through iterative removal of items on the basis of item-misfit statistics. The OSA–SF demonstrated adequate rating scale functioning, dimensionality, item and person goodness of fit, item targeting, item hierarchies, and item and person separation.

Conclusions and Relevance: Findings indicate that the OSA–SF is a valid and reliable measure that can guide client-centered goal setting and intervention planning for adults receiving acute care and acute inpatient rehabilitation.

What This Article Adds: The OSA 2.2 and the OSA–SF offer a client-centered approach to evaluating patients’ self-reported ability and ratings of the importance of performing everyday occupations. These assessments can guide client-centered goal setting in acute care and acute inpatient rehabilitation.

OBJECTIVE. Our objective was to perform initial psychometric analysis of the Multiple Errands Test Home Version (MET–Home), which was designed to assess the influence of poststroke executive dysfunction on in-home task performance.

METHOD. We examined the reliability and validity of the MET–Home in adults with stroke (n = 23) and individually matched control participants (n = 23). All participants completed a series of assessments during a single in-home visit.

RESULTS. Notable differences in MET-Home subscores were discovered between participants with stroke and control participants. Participants with stroke omitted more tasks, broke more rules, passed by tasks more often, and were less efficient than matched control participants. The MET–Home demonstrated evidence of adequate internal consistency, excellent interrater reliability, and significant moderate associations with several tests.

CONCLUSION. This preliminary study suggests that the MET–Home differentiates between adults with stroke and matched control participants. The MET–Home provides evidence of initial reliability and validity among adults with stroke.

OBJECTIVE. The purpose of this study was to identify the needs of military service members with chronic symptoms after mild traumatic brain injury (mTBI) that fall within the scope of occupational therapy practice.

METHOD. In this qualitative descriptive study, service members with a history of mTBI (N = 12) participated in semistructured interviews about their injury history, symptoms, daily routines, challenges, and plans.

RESULTS. Two main themes were identified: occupational changes and plans for the future. Occupational changes contains six subthemes: (1) rest and sleep, (2) activities of daily living and instrumental activities of daily living, (3) work, (4) social participation, (5) play and leisure, and (6) education. Plans for the future contains three subthemes: (1) supports, (2) barriers, and (3) fears.

CONCLUSION. Occupational therapists who work with this population should consider all areas of occupation, especially sleep, during assessment and treatment planning. Some clients may require additional support for preparing for civilian life.

OBJECTIVE. We examined the literature to identify reports of sensory integration concerns in children with functional defecation issues and to explore whether difficulty processing sensation may be related to their challenging bowel management behaviors.

METHOD. A scoping review was used to address the research question. We sourced articles from six databases in three languages, searched reference lists of all included articles, and identified additional articles through discussion with experts in the field.

RESULTS. Twelve articles were included in the final synthesis, identifying 15 challenging behaviors potentially related to sensory integration concerns.

CONCLUSION. We summarize research documenting sensory integration concerns in children with functional defecation issues, providing researchers and clinicians with an overview of the current state of understanding.

Importance: Pacing is a key pain management strategy used by occupational therapy practitioners when working with people with chronic pain. However, there is a paucity of evidence and a lack of consensus regarding the effectiveness of pacing as a pain management strategy for people with chronic pain.

Objective: To evaluate the evidence for the effectiveness of pacing as a learned strategy for people with chronic pain.

Data Sources: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to undertake a systematic review. Six databases were searched in March 2016 for randomized controlled trials (RCTs). Combinations of keywords and MeSH terms were used as search terms.

Study Selection and Data Collection: We sought intervention studies that included participants using pacing as a strategy. Studies were assessed for eligibility on the basis of predetermined criteria. Of the 2,820 articles located, 7 RCTs met inclusion criteria.

Findings: Pacing does not reduce the severity of pain or alter psychological traits; however, it can assist in lessening joint stiffness and the interference of fatigue and in decreasing the variability of physical activity.

Conclusions and Relevance: Current evidence supports the delivery of a learned pacing intervention to reduce the interference of fatigue, reduce joint stiffness, and decrease physical activity variability but does not support the use of learned pacing to reduce pain severity. Future research should investigate the effectiveness of pacing as a pain management strategy within the International Classification of Functioning, Disability and Health domains of activity and participation.

What This Article Adds: This systematic review examines existing research on pacing as a learned intervention strategy. The findings will support the clinical reasoning of occupational therapy practitioners, to determine when a learned pacing strategy is indicated, and considerations for how it may be delivered.

OBJECTIVE. This study’s objective was to test the psychometrics of Smith’s (2013) Low Vision Independence Measure (LVIM) using the Rasch model.

METHOD. A cohort design was used with 93 participants receiving occupational therapy for low vision. Confirmatory factor analysis (CFA) with a parceling approach was used to test the LVIM factors and Rasch analysis to examine item-level psychometrics.

RESULTS. Participants’ average age was 78.9 yr (standard deviation = 12.1), and the majority were female (72.8%) with macular degeneration (62.3%). The CFA revealed two measurement factors: visual field or scotoma (n = 28) and visual acuity (n = 24). We removed six misfitting items, and the two factors of the revised LVIM demonstrated good rating scale function, good internal consistency (person reliability: visual field, .87; visual acuity, .90), good precision (person strata: visual field, 3.91; visual acuity, 4.40), no ceiling or floor effects, and no differential item functioning.

CONCLUSION. The revised LVIM demonstrates good psychometrics on the Rasch model and can be used as a valid outcome measure in low vision rehabilitation.

Importance: Having a test to evaluate hand function is fundamental to occupational therapy practice.

Objective: To assess the psychometric properties of the Italian version of the Jebsen–Taylor Hand Function Test (JTHFT).

Design: Cross-sectional study.

Setting: Three health care institutions in Rome, Italy.

Participants: 136 people with injuries, burns, or neurological diseases of the hand.

Intervention: No intervention was provided.

Outcomes and Measures: We administered the JTHFT, an assessment of fine motor skills during performance of activities of daily living, and compared results with dynamometer readings.

Results: The mean ± standard deviation total time required to perform all subtests was 89.47 ± 67.98 s for the dominant hand (DH) and 167.11 ± 257.58 s for the nondominant hand (NDH). Reliability procedures were applied to data from 51 participants; mean intrarater intraclass correlation coefficient (ICC) was .814 for the DH and .981 for the NDH, and mean interrater ICC was .818 for the DH and .821 for the NDH. Pearson’s correlation coefficients were significant.

Conclusion and Relevance: Results support the use of the Italian version of the JTHFT as a measure of functional dexterity in people with upper limb disorders.

What This Article Adds: The JTHFT is a valid and reliable assessment tool for nonspecific hand diseases. Italian health professionals can now use the JTHFT with more confidence.

BACKGROUND. Little is known regarding how repetitive finger movement performance, an assessment of bradykinesia (slowness of movement), is related to fine-motor dexterity tasks in people with Parkinson’s disease (PD).

OBJECTIVE. This pilot study examined the relationship between the performance of fine-motor dexterity tasks and repetitive finger movement in people with PD.

METHOD. Forty-six participants with PD completed an acoustically cued repetitive finger movement task (1–3 Hz). Movement amplitude, movement rate difference, and coefficient of variation were obtained for each tone rate. Participants also completed a buttoning and Purdue pegboard assembly task. Buttoning time and number of assemblies were recorded.

RESULTS. A significant association was found between movement rate difference and movement rate difference coefficient of variation and buttoning performance in which higher movement rate and higher variability were associated with slower buttoning times. No significant associations between any of the repetitive finger movement outcome measures and Purdue pegboard assembly performance were revealed.

CONCLUSION. Changes in movement amplitude and movement rate may influence fine-motor dexterity tasks differently. Thus, it is important to consider the quantitative assessment of both movement rate and movement amplitude because they may indicate differential clinical applications in the treatment of people with PD.

When designing international educational collaborations, occupational science and occupational therapy educators must consider how occupational justice can be a linchpin for students’ learning. This article describes an international collaboration involving 52 undergraduate occupational science students in the United States and 41 undergraduate occupational therapy students in South Africa. The students participated in six synchronous video conferences in 2016, during which they gave group presentations about four occupational science constructs and engaged in general question-and-answer sessions. Forty percent of the students provided feedback about the interactions using a six-item open-ended electronic questionnaire, which we analyzed using directed content analysis. Our findings suggest that the collaboration helped the students develop more nuanced understandings of disciplinary constructs, international peers, and themselves, providing a platform from which to engage with the big idea of occupational justice. Refinements to this collaboration are aimed at drawing on students’ increased critical consciousness to further develop their knowledge about occupational justice.

OBJECTIVE. We explored the cultural beliefs that influence Latino-American mothers’ feeding practices with their young children and the sources they referenced in making food choices for their children.

METHOD. We conducted semistructured interviews with 12 Latino-American mothers focusing on their experiences of feeding their young children. Data analysis, based in grounded theory, consisted of interview transcription, content analysis, coding, and theme development.

RESULTS. We identified four themes summarizing the mothers’ feeding practices: (1) “Grandma knows best,” (2) “I want my child(ren) to be healthy,” (3) “always soup and always rice,” and (4) “mealtime is family time.”

CONCLUSION. Occupational therapy practitioners need to obtain accurate information from families about feeding practices and to understand and interpret those practices in broader cultural contexts to design and implement targeted feeding intervention strategies that avoid stereotyping or misinterpreted information. To promote family-centered, meaningful interventions, practitioners must understand the cultural influences on feeding practices and be sensitive to mothers’ needs.

Importance: A growing body of evidence supports service dogs’ positive psychosocial impact on people with a chronic condition, but very little is known about the effect of service dogs on the family members with whom they live.

Objective: To measure the impact that a service dog may have on family member functioning.

Design: Cross-sectional with a single time-point assessment.

Setting: Data were collected via a self-report survey completed online, over the phone, or by mail.

Participants: Potential participants were recruited from national service dog provider Canine Assistants. Participants were caregivers or spouses of a person with a disability or illness who either currently had a service dog (n = 51) or was on the waitlist to receive one (n = 77). Participants were 50 family members (46 parents–caregivers and 4 spouses–partners) living with a service dog and 76 family members (68 parents–caregivers and 8 spouses–partners) whose family member was on the waitlist to receive one.

Outcomes and Measures: Participants completed standardized measures to quantify psychosocial health and functioning, health-related quality of life (HRQOL), and family functioning.

Results: Living with a service dog was most closely associated with less health-related worry and better overall psychosocial health and emotional functioning, less total family impact from the chronic condition, and better emotional HRQOL.

Conclusions and Relevance: These findings provide preliminary evidence that, in addition to having an impact on recipients, service dogs can affect several aspects of family members’ psychosocial health and functioning.

What This Article Adds: This research demonstrates that the impact of a service dog may extend beyond the recipient and have positive impacts on family members’ psychosocial functioning as well. Occupational therapy practitioners should include family members in discussions regarding the integration of a service dog into the home and recognize the potential for family-wide effects from the service dog’s assistance.

Importance: Frailty is common in later life and increases older adults’ risk for early disability, institutionalization, and mortality.

Objective: To explore the research literature on occupational therapy interventions to improve outcomes among frail, community-dwelling older adults.

Design: Scoping review of the peer-reviewed literature about occupational therapy interventions and frailty published between January 1996 and January 2017.

Results: Ten studies met the inclusion criteria. The majority of the studies focused on adults age 65 yr or older, operationalized frailty as activities of daily living disability, and did not use validated frailty measures to identify frail older adults. Interventions were delivered both as a stand-alone intervention and as part of a multidisciplinary approach. Treatments focused on recommendations and training in use of adaptive devices or assistive technologies, performance of self-care, and recommendations for home modifications.

Conclusion: Additional research is warranted to build the evidence base and better inform the design and selection of occupational therapy interventions to improve outcomes among frail older adults.

Importance: Theory of mind (ToM) can be divided into two constructs: capacity and performance. Although severity of autism traits and verbal comprehension have been identified as being associated with ToM capacity, no study has yet verified their role in predicting the ToM performance of children with autism spectrum disorder (ASD).

Objective: To examine the differences and associations between ToM capacity and ToM performance and to verify the role of autism traits and verbal comprehension in predicting ToM performance in children with ASD.

Design: Cross-sectional study.

Setting: Pediatric rehabilitation hospitals and clinics.

Participants: One hundred four children with ASD who met the inclusion criteria.

Outcomes and Measures: We examined ToM capacity and ToM performance with the Theory of Mind Task Battery (ToMTB) and the Theory of Mind Inventory–2–Chinese version (ToMI–2–C). Severity of autism traits and verbal comprehension were assessed with the Social Responsiveness Scale, Second Edition (SRS–2), and the Verbal Comprehension Index (VCI) of either the Wechsler Preschool and Primary Scale of Intelligence–Fourth Edition or the Wechsler Intelligence Scale for Children–Fourth Edition. We conducted correlation and hierarchical regression analyses.

Results: Scores on the ToMI–2–C were significantly correlated with those on the ToMTB, SRS–2, and VCI (rs = .613, −.344, and .566, respectively; p < .01).

Conclusions and Relevance: ToM capacity is significantly correlated with ToM performance. Both severity of autism traits and verbal comprehension played an important role in predicting ToM performance of children with ASD after controlling for ToM capacity.

What This Article Adds: ToM capacity, severity of autism traits, and verbal comprehension were all significant predictors of ToM performance. Improving ToM capacity, severity of autism traits, and verbal comprehension of children with ASD would be beneficial to their ToM performance.

Importance: Health care providers’ knowledge of and comfort working with adults with developmental disabilities (DD) affect the quality of care this growing population receives. Previous research on this topic has not included occupational therapy practitioners.

Objective: To determine occupational therapy practitioners’ views about working with older adults with DD in traditional health care settings.

Design: Quantitative survey over 4 mo.

Participants: A random sample of 310 practitioners from the American Occupational Therapy Association’s Gerontology and Physical Disabilities Special Interest Sections working in traditional health care settings.

Outcomes and Measures: A researcher-developed survey to assess occupational therapy practitioners’ comfort, knowledge, challenge, and supports and barriers in regard to working with older adults with DD.

Results: In the 310 included surveys (31% response rate), most occupational therapy practitioners reported feeling comfortable (76.1%–80.0%) and knowledgeable (66.5%–68.4%) working with older adults with DD. Approximately 93% reported that work with older adults with DD was at least somewhat challenging. Key perceived barriers included clients’ cognitive needs, lack of caregiver collaboration, and challenging behavior.

Conclusion and Relevance: Most occupational therapy practitioners in traditional health care settings found working with older adults with DD challenging, and many did not feel sufficiently knowledgeable to meet the needs of this population. Similar to other health professionals, occupational therapy practitioners may benefit from additional resources to provide services to this population.

What This Article Adds: Older adults with DD receive occupational therapy services in hospitals, rehabilitation centers, nursing homes, and other medical settings. Because clients such as these are not common in these settings, occupational therapy practitioners who work there would like more tools to help provide good care.

Importance: Self-awareness of deficits, or the ability to understand the effects of impairments on daily life, is often diminished after a stroke. Diminished self-awareness influences participation in rehabilitation and functional outcomes.

Objective: To examine whether self-awareness of deficits changed over time after a stroke (N = 43) and whether metacognitive strategy training (n = 21) resulted in improved self-awareness compared with direct skill training (n = 22).

Design: Secondary analysis of data collected from a randomized controlled trial.

Setting: Inpatient stroke rehabilitation.

Participants: Adults with cognitive impairments after an acute stroke.

Intervention: Metacognitive strategy training is an approach in which clients are guided through a process of self-assessment and develop solutions for barriers to task performance. This approach was compared with direct skill training, in which the therapist provides specific instructions for task completion, removing the client-initiated assessment and problem-solving components.

Outcomes and Measures: Self-awareness measures included the Self-Regulation Skills Interview and Self-Awareness of Deficits Interview at baseline and 3 mo and 6 mo after the intervention. We used a one-way analysis of variance (ANOVA) to analyze change in self-awareness and a two-way ANOVA to examine differences between groups over time.

Results: There was a statistically significant and potentially meaningful difference over time in the self-awareness domain of strategy behavior, F(2) = 3.35, p = .039, but there were no differences in improvements between the metacognitive strategy and direct skill training groups.

Conclusions and Relevance: Self-awareness warrants further investigation to determine whether it improves naturally over time or through both interventions after stroke.

What This Article Adds: Self-awareness of deficits, and the use of strategies in particular, may improve in the early stages of stroke recovery, but the optimal approach for intervention remains unclear.

Importance: Attention deficit hyperactivity disorder (ADHD) is associated with driving deficits. Visual standards for driving define minimum qualifications for safe driving, including acuity and field of vision, but they do not consider the ability to explore the environment efficiently by shifting the gaze, which is a critical element of safe driving.

Objective: To examine visual exploration during simulated driving in adolescents with and without ADHD.

Design: Adolescents with and without ADHD drove a driving simulator for approximately 10 min while their gaze was monitored. They then completed a battery of questionnaires.

Setting: University lab.

Participants: Participants with (n = 16) and without (n = 15) ADHD were included. Participants had a history of neurological disorders other than ADHD and normal or corrected-to-normal vision. Control participants reported not having a diagnosis of ADHD. Participants with ADHD had been previously diagnosed by a qualified professional.

Outcomes and Measures: We compared the following measures between ADHD and non-ADHD groups: dashboard dwell times, fixation variance, entropy, and fixation duration.

Results: Findings showed that participants with ADHD were more restricted in their patterns of exploration than control group participants. They spent considerably more time gazing at the dashboard and had longer periods of fixation with lower variability and randomness.

Conclusions and Relevance: The results support the hypothesis that adolescents with ADHD engage in less active exploration during simulated driving.

What This Article Adds: This study raises concerns regarding the driving competence of people with ADHD and opens up new directions for potential training programs that focus on exploratory gaze control.

In this article, I advocate the expansion of self-management support from chronic to acute care as a means of increasing the value of services and highlighting the value of occupational therapy. Like people with chronic conditions, clients with acute conditions (1) need to participate in their own care, (2) require support for participation, (3) engage in care outside of traditional medical behaviors, and (4) benefit from a focus of care that extends beyond discrete episodes. Self-management support can facilitate adherence, promote holistic conceptualizations of health, and address long-term outcomes and costs. Given that self-management support aligns with occupational therapy’s philosophical roots, expansion of self-management support to acute care highlights the profession’s contribution to health promotion in this practice area.

Evidence Connection articles provide case examples of how practice decisions may be informed by findings of systematic reviews sponsored by the American Occupational Therapy Association Evidence-Based Practice Project. This Evidence Connection article is the second article in a two-part series. The first article described a case report of occupational therapy provided to a child with a diagnosis of autism spectrum disorder and challenges in sensory integration in a clinic setting (Parham et al., 2019). This article describes the same child’s occupational therapy service delivery by the occupational therapist working in the school setting.