American Journal of Occupational Therapy

The American Journal of Occupational Therapy (AJOT) remains the most highly ranked occupational therapy journal, as measured by its journal impact factor. AJOT’s goals are to remain occupational therapy’s leading research journal, publish high-quality research that reflects the breadth of research related to occupational therapy, and have disciplinary and interdisciplinary impact.

Surrounded by changes and opportunities, the profession of occupational therapy finds itself at a tipping point. We all have the power to make a difference. What bold action can you take to create meaningful change?

The occupational therapy profession has been experiencing substantial growing pains, and the environment presents uncertainty and opportunities. The profession has experienced the swing from the celebratory high of the American Occupational Therapy Association’s (AOTA’s) 2017 Centennial Celebration to the reality of internal and external challenges related to entry-level professional preparation, payment and practice shifts, and new service delivery directives—all during a contentious political, economic, and societal climate. Three Rs—relationships, resilience, and relevance—can guide the profession in a focus on restoring and creating meaningful yet strategic relationships, embracing a collective strength and capacity for personal and professional resilience, and committing to innovative action to ensure occupational therapy’s relevance as a health and human services profession. This Inaugural Presidential Address offers a message of simplicity and hope for the occupational therapy profession as well as a declaration of the AOTA president’s own grounding values and focus.

Throughout the years, leaders in the profession have challenged us to affirm the value of occupational therapy and to substantiate what we do. Occupational therapy practitioners have always focused on what most matters to clients in what is now called client-centered or patient-centered practice. We have also focused on client function to enable participation in everyday life. In a welcome shift, society’s views about health and meaning-making are becoming more congruent with the long-standing ideals of occupational therapy. Now, more than ever, we have a powerful opportunity to communicate our competence. But how do we assert our competence and the complexity of occupation with confidence? This lecture draws on the conceptual foundations of theories about competence and confidence and provides examples from the research literature, and a practitioner and client narrative to illustrate the factors that enable us to effectively demonstrate the value of occupational therapy.

Importance: This research provides practitioners with an understanding of play from the perspective of children with a high level of physical disability.

Objective: To explore the experience of play for children who have a high level of physical disability as a result of cerebral palsy.

Design: Interpretative phenomenological analysis. Children participated in three interviews each to discuss their experience of play. Visual methods, such as use of video and drawings, enabled a greater depth of discussion.

Setting: Participants’ homes.

Participants : Six children ages 6–11 yr with a high level of physical disability, recruited via snowball sampling and charities working with children with cerebral palsy.

Results: We found that making choices and controlling play were important for the children, that they often experienced play differently than their peers, and that they connected with others in play through humor and communication skills.

Conclusions and Relevance: Occupational therapy practitioners can respond to the findings by understanding the embodied unit, recognizing vista play, enabling expression of each child’s imagined self, supporting negotiation of identity and disability, recognizing participation in play through watching, enabling opportunities for belonging, enabling development of component skills for play, and supporting strategies for connection.

What This Article Adds: This article provides occupational therapy practitioners and other professionals with an understanding of play from the perspective of children who have a high level of physical disability.

Importance: Powered wheelchairs provide independence for people with mobility impairments; however, current training practices may not meet the needs of those with cognitive impairments. Shared-control teleoperation may have utility in a clinical setting when developing training suited to this population.

Objective: To explore the clinical utility of a shared-control teleoperation device for powered wheelchair assessment and training.

Design: In this qualitative study, we used two sequential semistructured interviews conducted a minimum of 2 wk apart. Thematic analyses were used with member checking, reflexive journaling, and triangulation of researchers to establish trustworthiness of the data.

Setting: Rehabilitation center and residential care and community settings.

Participants: Using purposive sampling, we recruited occupational therapists and physical therapists who were mostly female and who had a range of practice experience.

Results: Fifteen participants were interviewed, and two primary themes were identified: (1) “A big enabler” described how shared control provides opportunities to train people who may otherwise be denied powered mobility, and (2) “changing the learner experience” described how shared control may promote success in skill development through an alternative learning experience.

Conclusions and Relevance: Shared-control technology may have the potential to broaden the scope of therapeutic intervention by reducing risk to the driver and others in the environment and by facilitating alternative training approaches.

What This Article Adds: Technological advances that allow more control over a powered wheelchair by a clinician, known as shared control, may provide learning opportunities for people who are otherwise denied access to powered mobility. Shared control may also allow the use of new instructional techniques, increase safety in the training process, and reduce anxiety associated with learning.

Importance: The subjective meaning that people attach to their occupations may explain the association among participation, health, and well-being. To date, the subjective meaning of occupation among children has mostly been studied through qualitative studies. No study has yet quantitatively assessed the perceived meaning of everyday activities among children. Moreover, no study has assessed the associations between perceived meaning and actual participation.

Objective: To explore the perceived meaning—value, challenge, felt time, and autonomy—that typically developing children attribute to their everyday activities and to assess the correlations between children’s perceived meaning and their participation as assessed by parents.

Design: Cross-sectional study.

Setting: Community.

Participants: A convenience sample of 60 Israeli children (ages 6–12 yr) and their parents.

Outcomes and Measures: Parents completed the Children Participation Questionnaire–School, and children completed the Perceived Meaning of Occupation Questionnaire (PMOQ).

Results: Children valued their activities, they perceived the challenge as low, they felt that the time was almost equally distributed between time passing quickly and passing slowly, and they felt autonomous. The subjective perceived meanings were moderately correlated with the children’s actual participation.

Conclusions and Relevance: Children are capable of reflecting on the meaning of their everyday activities. The PMOQ may assist occupational therapy practitioners in eliciting their young clients’ perspectives regarding their everyday occupations. The results contribute to the occupational science literature in the context of child development.

What This Article Adds: The PMOQ enables children to reflect on their subjective perceived meanings of occupations. The subjective perceived meanings of occupations are moderately correlated with the children’s actual participation. The PMOQ may broaden the potential pathways to facilitating children’s meaningful participation in everyday occupations.

Importance: Elucidation of the relationship between belief conflict and occupational dysfunction in occupational health is needed. Knowledge of this relationship is important to the development of preventive occupational therapy.

Objective: To examine the relationship between belief conflict and occupational dysfunction.

Design: Cross-sectional study. Participants were recruited via nonrandom sampling, and data were analyzed with Bayesian modeling.

Setting: Health care institutions in Japan.

Participants: Participants were 890 health care workers.

Outcomes and Measures: Data were collected by means of the Participant Profile, the Assessment of Belief Conflict in Relationship–14 (ABCR–14), and the Classification and Assessment of Occupational Dysfunction.

Results: Belief conflict and occupational dysfunction showed moderate to strong positive correlations. The cutoff value for the ABCR–14 was estimated to be 58 points. The odds ratio indicated that groups with high belief conflict were very likely to experience occupational dysfunction.

Conclusions and Relevance: These findings show that belief conflict and occupational dysfunction are more than moderately associated. Longitudinal studies are needed to prove the causal relationship between belief conflict and occupational dysfunction.

What This Article Adds: Considering that those falling into the high-belief-conflict group are likely to experience occupational dysfunction, it is necessary to focus efforts not only on teamwork but also on the improvement of health. Preventive occupational therapy needs to assume a leading role in improving the occupational health of health care workers who experience belief conflict and occupational dysfunction.

This study examined whether sleep quality is associated with hand function above and beyond what can be explained by the effect of pain and carpal tunnel syndrome (CTS) severity on hand function in clients with CTS. The sample included 53 adults ages 30–86 yr. The Manual Ability Measure–20, Pittsburgh Sleep Quality Index, visual analog scale for pain, and electromyography for CTS diagnosis and severity level were used to measure outcomes. Sleep quality was significantly associated with manual ability after controlling for CTS severity and pain. In CTS care, attention to sleep is significant because it may promote hand function.

OBJECTIVE. We evaluated the construct validity (i.e., unidimensionality and convergent validity) and Rasch reliability of the 20-item Comprehensive Occupational Therapy Evaluation Scale (COTES) in people with schizophrenia.

METHOD. Retrospective chart review was used to collect COTES data from 505 inpatients with schizophrenia. For construct validity, we first examined unidimensionality of each of the three COTES subscales using Rasch analysis. After unidimensionality was supported, we examined convergent validity using Pearson’s r and Rasch reliability of the individual subscales.

RESULTS. After deleting two misfitting items, the remaining items (i.e., the COTES–18) showed unidimensionality. Infit and outfit mean squares were 0.73–1.25. Moderate correlations were found among the three COTES–18 subscales (rs = .57–.71). The Rasch reliabilities of the three subscales were .83–.92.

CONCLUSION. The COTES–18 has sufficient construct validity and reliability to assess three specific dimensions of behavior affecting occupational performance in people with schizophrenia.

Importance: In Spain, culturally adapted tools are needed to assess sensory processing in adolescents and adults.

Objective: To adapt the Adolescent/Adult Sensory Profile (AASP) so that it is culturally appropriate for use in Spain.

Design: Following standard procedures for cultural adaptation, we completed direct and back translation, conducted cognitive interviews, and examined test–retest reliability.

Participants: Cognitive interviews were conducted with 18 participants ages 11–13 yr. Test–retest reliability was calculated with different samples of 30 participants who were Spanish speaking only and 30 who were Spanish and English speaking.

Results: The cognitive interviews revealed no serious difficulties in comprehension. The linguistic expert made necessary adjustments, and test–retest reliability of items showed low intraclass correlation coefficients (ICCs; i.e., <.50) for two items in the monolingual group and five items in the bilingual group. These items were reviewed and revised by the linguistic expert, and subsequent test–retest reliability showed only one item with an ICC of <.50.

Conclusions and Relevance: The cultural adaptation of the AASP for Spain is conceptually and semantically equivalent to the original version and provides a culturally sensitive measure of sensory processing for adolescent and adult Spanish populations.

What This Article Adds: The cultural adaptation of assessment tools is an essential part of occupational therapy clinical intervention. We describe the cultural adaptation to Spain of the Adolescent/Adult Sensory Profile.

Importance: Despite criticisms of disability simulation and the limited research on the topic, disability simulation activities are often used to increase understanding of the challenges faced by people with disabilities.

Objective: To compare two disability awareness activities (disability simulation and an accessibility audit).

Design: A matched pretest–posttest design with two disability awareness activities to study attitudes, affect, cognitions, and behaviors toward disability.

Setting: A small college in New England.

Participants: Eighty-eight undergraduate students.

Intervention: Participants took baseline tests online, after which they participated in a 1-hr on-campus activity. Participants were randomly assigned to either the disability simulation activity or the accessibility audit activity. Participants took posttest surveys online within 1 wk of completing the intervention.

Results: Results demonstrated that both activities lowered negative emotional responses toward people with disabilities, but participants who completed the tape measure activity had a larger decrease in scores. No significant differences were found between the scores of people who completed the different disability awareness activities.

Conclusions: Given the many criticisms of disability simulation practices and marginal differences between activities, it is time for disability simulation activities to be retired from use.

What This Article Adds: The results of this study demonstrate that disability simulation is no better than an accessibility audit in improving attitudes toward people with disabilities. Therefore, educators should cease use of these activities.

Importance: As the use of simulation in occupational therapy education continues to increase, so too does the need for continued research on its impact on clinical practice performance and the value of simulation as a pedagogic method.

Objective: To develop a survey to measure the perceived impact of high-fidelity, high-technology simulation experiences during occupational therapy education on occupational therapists’ performance and to describe occupational therapists’ perceptions of the impact of simulation on clinical skills.

Design: Cross-sectional descriptive study.

Setting: Online survey administration.

Participants: Occupational therapists completed an online survey to measure their perceptions of the impact of high-fidelity, high-technology simulation experiences on essential skills in four performance domains: confidence, knowledge, clinical skills, and patient safety skills.

Results: Sixty-seven occupational therapists perceived participation in simulation experiences during occupational therapy education had more impact on transferring clients and using safe body mechanics than on communicating with clients, assessing vital signs, or applying clinical reasoning. The survey items had evidence of content validity, and scores showed good internal consistency reliability.

Conclusions: Survey results suggested high-fidelity, high-technology simulation during occupational therapy education may affect clinical practice performance. Additional research is needed to determine the effectiveness of simulation education in preparing occupational therapists for clinical practice.

What This Article Adds: The survey developed in this study is a reliable measure of the impact of simulation experiences on clinical practice performance of occupational therapists.

Importance: A recent reanalysis of data from the Well Elderly (WE) 2 study purportedly indicated that the intervention did not achieve clinically meaningful or statistically significant effects; this article addresses these criticisms.

Objective: To contextualize the WE 2 study as targeting a nonclinical population and demonstrate that the intervention produced substantively important, statistically significant effects.

Design: Secondary analysis of WE 2 intervention-based pre–post change scores.

Setting: The original trial occurred primarily in senior centers and senior housing facilities in greater Los Angeles.

Participants: Independent-living older adults (N = 324) who were assessed before and after intervention.

Intervention: The WE intervention, a version of the Lifestyle Redesign® (LR) approach, was administered by occupational therapists over 6 mo by means of group and individual sessions.

Outcomes and Measures: The 36-item Short Form Health Survey, the Life Satisfaction Index–Z, and the Center for Epidemiologic Studies Depression Scale.

Results: The WE intervention was associated with statistically significant improvement on 10 of 12 outcome variables that were examined.

Conclusions and Relevance: Because the WE intervention was hypothesized to reduce age-related decline and followed a population-oriented approach, the expectation that average results would be clinically meaningful was inappropriate. The intervention produced positive effects across a wide array of outcome domains. In settings in which clinical meaningfulness is an appropriate index of intervention outcomes, evidence suggests that LR produces effects that are clinically meaningful. As an evidence-based intervention, LR should be considered useful both in population-oriented contexts and in addressing discrete health conditions.

What This Article Adds: Valid analyses demonstrate that the positive experimental effects of the WE 2 study are, in fact, genuine and cost-effective, and LR in clinically oriented contexts has produced statistically significant, clinically meaningful results. Clearly and accurately representing the evidence base of occupational therapy in prevention and chronic care is of critical importance to advance the field as a whole.