American Journal of Occupational Therapy

The U.S. population is aging at an unprecedented rate, creating both opportunities and challenges for the overall health of the nation. Occupational therapy practitioners can inform important health policies by developing an understanding of the basis for relevant laws and programs and how occupational therapy principles relate to policy goals. This column discusses the Older Americans Act of 1965 (reauthorized as the Supporting Older Americans Act of 2020) and describes ways in which the objectives of this legislation align with the principles and practice of occupational therapy. Recommendations are provided for how the field of occupational therapy can enhance current policy development and debate, thus leading to expanded opportunities for the profession.

Importance: Occupational therapy practitioners can use therapeutic activity to promote veterans’ well-being, but the mechanisms through which participation promotes well-being are poorly understood.

Objective: To examine whether coping ability, meaningful activity, and social support mediate the relationship between participation and two indicators of veterans’ overall well-being: life meaning (psychological well-being) and life satisfaction (subjective well-being).

Design: Explanatory cross-sectional design. We used two multiple mediation models to test whether coping ability, meaningful activity, and social support explained the relationship between participation and both life meaning and life satisfaction. Models were adjusted for demographic characteristics and service-related health conditions (e.g., posttraumatic stress disorder).

Setting: Community.

Participants: Three hundred eighty-nine community-based veterans attending college.

Intervention: None.

Outcomes and Measures: Measures of participation, coping ability, meaningful activity, social support, life meaning, life satisfaction, and service-related health conditions.

Results: Meaningfulness of activity partially explained the relationship between participation and both psychological well-being (B = 0.16, standard error [SE] = 0.04, 99% confidence interval [CI] [0.07, 0.27]) and subjective well-being (B = 0.14, SE = 0.03, 99% CI [0.07, 0.24]). Social support partially explained the relationship between participation and subjective well-being (B = 0.05, SE = 0.02, 99% CI [0.01, 0.11]). These findings persisted when symptoms of service-related health conditions were accounted for.

Conclusions and Relevance: Veterans’ participation is associated with a greater sense of meaningful activity and social support, which in turn promotes psychological and subjective well-being. Occupational therapy practitioners may promote veterans’ well-being by supporting engagement in activities that elicit meaning and enable social interaction, although further study is needed.

What This Article Adds: This is among the first studies to test mechanisms underlying the relationship between veterans’ engagement in activities and their overall well-being. Results may inform treatment theories for activity-based interventions in the veteran population. For example, results indicate that occupational therapy interventions that facilitate engagement in meaningful and shared activities could be developed to promote veterans’ well-being.

Importance: There is a critical gap in the literature regarding the efficacy of occupational therapy interventions for pediatric hematopoietic cell transplantation (HCT) patients.

Objective: To demonstrate that occupational therapy 4–5×/wk during inpatient hospitalization positively affects strength, coordination, and independence in activities of daily living (ADLs) of pediatric patients during HCT.

Design: Retrospective study.

Setting: Inpatient bone marrow transplant unit at a children’s hospital.

Participants: Thirty-two pediatric patients admitted for HCT.

Outcomes and Measures: Patients were seen by an occupational therapist as part of an interdisciplinary program. Interventions included play and leisure engagement, upper extremity therapeutic exercises, fine motor activities, and ADL training. Strength, coordination, and daily living skills data were documented prospectively and analyzed retrospectively to compare differences between patients seen by occupational therapy at high versus low frequency.

Results: For grip strength (dynamometer), fine motor dexterity (the 9-Hole Peg Test), and independence in ADLs (an ADL functional measure and the Pediatric Evaluation of Disability Inventory–Computer Adaptive Test Daily Activities), the high-frequency group had a significantly smaller decrease in performance from time of admission at pretransplant (baseline) to peak decline after transplant. Grip strength and ADL scores for the high-frequency group returned to baseline at time of discharge more readily than for the low-frequency group.

Conclusions and Relevance: Participation in occupational therapy 4–5×/wk had positive effects on strength, coordination, and independence in ADLs for patients undergoing HCT.

What This Article Adds: This article provides evidence that occupational therapists are an important part of the interdisciplinary team treating pediatric bone marrow transplant patients. It also demonstrates that occupational therapy interventions delivered at a high frequency can have a positive impact on upper extremity strength and independence in ADLs.

Importance: Occupational therapy can play a role in primary care management of chronic diseases among older adults.

Objective: To assess the feasibility of delivering a primary care occupation-focused intervention (Integrated PRimary care and Occupational therapy for Aging and Chronic disease Treatment to preserve Independence and Functioning, or i-PROACTIF) for older adults with chronic disease.

Design: Feasibility study comparing i-PROACTIF with complex care management using a two-group randomized controlled trial design with data gathered at baseline and during and after the 8-wk intervention.

Setting: Family medicine clinic serving an urban, low-income, working-class community.

Outcomes and Measures: Feasibility indicators were recruitment, retention, utility of clinical assessments, and acceptability of interventions assessed through feedback surveys completed by patients and primary care providers (PCPs). Patient outcomes, including perspectives on chronic illness care, occupational performance, and overall well-being, were collected using standardized, validated measures and analyzed descriptively.

Participants: Eighteen adult volunteers, ages ≥50 yr, with heart disease, arthritis, and uncontrolled diabetes completed the study. Ten PCPs completed feedback surveys.

Intervention: i-PROACTIF focuses on preserving functional independence, is based on the Person–Environment–Occupation framework, and consists of two assessment sessions and six weekly treatment sessions.

Results: Recruitment goals were achieved, with an 86% retention rate. Clinical measures unearthed deficits in areas that were unreported or underreported by patients. Participants reported being extremely satisfied with the intervention. Physicians and nurses also supported the intervention. Both groups showed improved scores on most outcomes.

Conclusion and Relevance: Delivering and evaluating i-PROACTIF was feasible and acceptable. Future efficacy trials are needed before it can be used in clinical settings.

What This Article Adds: The results of this study can inform future occupational therapy interventions and clinical trials in primary care for older adults with chronic conditions.

Importance: The Low Vision Independence Measure (LVIM) was designed to measure the effectiveness of occupational therapy to improve visual ability in low vision rehabilitation.

Objective: To validate the Revised LVIM (LVIM–R) as an outcome measure by determining its sensitivity to visual ability changes after occupational therapy.

Design: In this observational study, LVIM–R scores were collected before and after customary low vision intervention.

Setting: Home health agency or outpatient facility.

Participants: Forty-four participants with a mean age of 80.2 yr (standard deviation = 11.2) and an average length of visual impairment of 6.2 yr. Twenty-three participants (52.3%) were treated in an outpatient setting, and 21 (47.7%) were treated in the home. The majority of participants were non-Hispanic White (92.8%) and had macular degeneration (54.5%).

Intervention: Customary low vision intervention by occupational therapists.

Outcomes and Measures: LVIM–R scores were collected before and after intervention, and participants’ pre- and posttest scores were anchored into Rasch-calibrated item parameters.

Results: Paired t tests demonstrated significant increases in person measures with large effect sizes for both constructs of the LVIM–R, the visual field or scotoma (t[43] = 6.46, p < .0001; Cohen’s d = 0.92) and visual acuity (t[43] = 9.08, p < .0001; Cohen’s d = 1.14) constructs.

Conclusions and Relevance: The LVIM–R is sensitive to changes in visual ability in clients who have good rehabilitation potential and can be used to examine the effectiveness of occupational therapy for low vision.

What This Article Adds: The LVIM–R is useful for measuring occupational therapy outcomes in low vision rehabilitation in the home or in outpatient settings.

Importance: Spasticity is one of the most common and disabling motor impairments after stroke.

Objective: To examine the evidence for the effectiveness of stretching interventions, including splinting, on reducing upper extremity spasticity, increasing hand function, and improving functional tasks for adults with poststroke spasticity.

Data Sources: Databases searched were MEDLINE, CINAHL, OTseeker, AgeLine, and the Cochrane Library; results were limited to studies published from 2004 to January 2017.

Study Selection and Data Collection: Following PRISMA guidelines, we included articles describing Level I–III studies with participants who were adults with upper extremity spasticity and received a stretching intervention.

Findings: Eleven articles describing 6 Level I and 5 Level III studies met inclusion criteria.

Conclusion and Relevance: For reducing upper extremity spasticity, low strength of evidence was found to support the use of static splinting, strong strength of evidence was found for the use of stretching devices, and low strength of evidence was found to support the use of dynamic splinting; no evidence was found for manual stretching to address spasticity. For increasing hand function, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices. For improving functional tasks, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices.

What This Article Adds: This updated synthesis summarizes the current literature regarding the effectiveness of stretching interventions to improve poststroke spasticity, hand function, and functional tasks.

Importance: Head-mounted displays for virtual reality (HMD–VR) may be used as a therapeutic medium in physical rehabilitation because of their ability to immerse patients in safe, controlled, and engaging virtual worlds.

Objective: To explore how HMD–VR has been used in adult physical rehabilitation.

Data Sources: A systematic search of MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO, and ERIC produced 11,453 abstracts, of which 777 underwent full-text review.

Study Selection and Data Collection: This scoping review includes 21 experimental studies that reported an assessment or intervention using HMD–VR in a physical rehabilitation context and within the scope of occupational therapy practice.

Findings: HMD–VR was used for assessment and intervention for patients with a range of disorders, including stroke, multiple sclerosis, spinal cord injury, and Parkinson’s disease.

Conclusions and Relevance: HMD–VR is an emerging technology with many uses in adult physical rehabilitation. Higher quality clinical implementation studies are needed to examine effects on patient outcomes.

What This Article Adds: We review existing research on how immersive virtual reality (e.g., using head-mounted displays) has been used for different clinical populations in adult physical rehabilitation and highlight emerging opportunities in this field for occupational therapists.

Importance: Resuming driving after a change in functional ability is challenging for patients with a neurological condition. Although a combination of assessment tools has been suggested for use in driving evaluation, resources and availability of tools have been a problem.

Objective: To examine the predictive ability of two commonly used tools, the Motor-Free Visual Perception Test (MVPT) and the Trail Making Test, Parts A and B (TMTA and TMTB), on on-road driving performance.

Design: Retrospective chart review of 82 patient charts between 2015 and 2016.

Setting: Local rehabilitation hospital.

Participants: Eighty-two patients with a primary neurological diagnosis (general neurological condition, n = 13; spinal cord injury, n = 11; stroke, n = 58).

Outcomes and Measures: MVPT, TMTA, and TMTB.

Results: Among the patients, 36 passed and 46 failed the on-road evaluation. The TMTA and TMTB scores were significantly different between those who passed or failed the on-road evaluation. Logistic regression analyses revealed that the TMTB completion time was the only significant predictor of on-road driving performance (for the all-patient model, 66% prediction accuracy, −2 log-likelihood [LL] = 93.47, exp β = 0.98; for the stroke-only model, 76% prediction accuracy, −2LL = 59.61, exp β = 0.97).

Conclusions and Relevance: Our findings suggest that the TMTB is a better predictor of on-road driving performance for patients with a neurological condition than the MVPT. The findings shed light on the importance of selecting proper tools when assessing driving performance. Future prospective studies with a wider array of predictive variables are recommended to support the present findings.

What This Article Adds: Occupational therapists should revisit the use of the MVPT in driving assessment and consider multiple assessment tools when evaluating and predicting driving performance.

Importance: Few predictive models for later handwriting difficulties have been developed for kindergarteners.

Objective: To develop a nomogram for the purpose of detecting the risk of later poor Chinese handwriting among Taiwanese kindergarteners.

Design: One-year prospective longitudinal, observational study.

Setting: Kindergarten and elementary school.

Participants: One hundred fifty-six kindergarteners were included. In first grade, they were grouped into the normal and poor handwriting groups on the basis of handwriting performance in first grade.

Outcomes and Measures: Participants received fine motor (FM), visual–perceptual (VP), and visual–motor integration tests in kindergarten and handwriting assessments in first grade.

Results: Logistic regression results indicated that younger age at school entry and lower scores on measures of FM and VP in kindergarten increased the risk for later poor handwriting. The area under the receiver operating characteristic curve in the nomogram built with these risk factors was .75, indicating that the nomogram had acceptable diagnostic value.

Conclusions and Relevance: This nomogram could be used as a screening tool to detect kindergarteners at risk of poor Chinese handwriting in first grade.

What This Article Adds: This study is the first to establish a nomogram constructed with significant predictors in kindergarten of a child’s probability of poor handwriting later in first grade. This predictive nomogram may help occupational therapists, educators, and parents identify at-risk kindergarteners early for the purpose of early interventions to prevent later poor Chinese handwriting.

Importance: Practitioners working in school settings have a variety of job-related responsibilities in addition to direct service provision. Models of best practice indicate that a workload approach to service delivery allows practitioners to provide effective and productive interventions in the school setting; however, current information related to service delivery by school-based practitioners in the United States is lacking.

Objective: To explore current caseloads, service delivery models, implementation of workload models, knowledge of state and local policies, and job satisfaction of school-based occupational therapy practitioners and how they relate to best practice.

Design: Web-based survey.

Setting: School-based practice.

Participants: Three hundred seventy-one school-based practitioners from across the United States completed the study.

Outcomes and Measures: Investigator-developed survey with both closed- and open-ended questions.

Results: School-based practitioners recruited via social media platforms and snowball sampling completed an online survey. Results indicate that practitioners wanted to move their practice to a workload model but cited lack of administrative support, time, procedural knowledge, and decreased advocacy skills as barriers to implementation. Moreover, despite current philosophy regarding best practice, occupational therapy practitioners continue to provide services outside of the classroom and other natural settings.

Conclusions and Relevance: There seems to be a disconnect between intent (e.g., service delivery in natural settings, expanding the scope of practice) and current practice trends. Practitioners need support to advocate for and implement alternative service delivery models and to incorporate a workload approach to meet the diverse needs of students in educational settings.

What This Article Adds: Practical resources related to caseload and workload guidelines and implementation, service delivery models, and methods of advocacy and negotiation skills are needed to support practitioners as they advocate for changes in their practice.

Importance: Constraint-induced movement therapy (CIMT) is a common treatment for children with unilateral cerebral palsy (CP). Although clinic-based assessments have demonstrated improvements in arm function after CIMT, whether these changes are translated and sustained outside of a clinic setting remains unclear.

Objective: Accelerometers were used to quantify arm movement for children with CP 1 wk before, during, and 4 wk or more after CIMT; measurements were compared with those from typically developing (TD) peers.

Design: Observational.

Setting: Tertiary hospital and community.

Participants: Seven children with CP (5 boys, 2 girls; average [AVE] age ± standard deviation [SD] = 7.4 ± 1.2 yr) and 7 TD peers (2 boys, 5 girls; AVE age ± SD = 7.0 ± 2.3 yr).

Intervention: 30-hr CIMT protocol.

Outcomes and Measures: Use ratio, magnitude ratio, and bilateral magnitude were calculated from the accelerometer data. Clinical measures were administered before and after CIMT, and parent surveys assessed parent and child perceptions of wearing accelerometers.

Results: During CIMT, the frequency and magnitude of paretic arm use among children with CP increased in the clinic and in daily life. After CIMT, although clinical scores showed sustained improvement, the children’s accelerometry data reverted to baseline values. Children and parents in both cohorts had positive perceptions of accelerometer use.

Conclusions and Relevance: The lack of sustained improvement in accelerometry metrics after CIMT suggests that therapy gains did not translate to increased movement outside the clinic. Additional therapy may be needed to help transfer gains outside the clinic.

What This Article Adds: Accelerometer measurements were effective at monitoring arm movement outside of the clinic during CIMT and suggested that additional interventions may be needed after CIMT to sustain benefits.

Importance: A reliable observational measure is necessary to measure clients’ behaviors as they participate in activities. The Comprehensive Occupational Therapy Evaluation Scale (COTES) is designed to measure strengths and difficulties in various behaviors that support occupational performance.

Objective: To examine the test–retest reliability of the COTES (overall score and scores on the General Behavior, Social Behavior, and Work Behavior subscales) and calculate the minimal detectable change (MDC) for people with schizophrenia.

Design: Prospective, observational study.

Setting: A psychiatric center.

Participants: COTES data for 118 people with schizophrenia were collected from occupational therapy records. Data from the initial and second COTES measurements were chosen for analysis.

Outcomes and Measures: Test–retest reliability of the overall scale and three subscales was evaluated using the intraclass correlation coefficient (ICC). The MDC was calculated on the basis of the standard error of measurement.

Results: ICCs for the overall scale and three subscales ranged from .91 to .97. The MDC values (MDC%) were 6.5 (10.5%) for the overall scale, 3.4 (13.5%) for the General Behavior subscale, 2.3 (15.2%) for the Social Behavior subscale, and 2.4 (11.0%) for the Work Behavior subscale.

Conclusion and Relevance: The COTES has good test–retest reliability. Clinicians and researchers can use the MDC values provided in this study to explain the implications of change scores for behaviors that affect occupational performance for people with schizophrenia.

What This Article Adds: The COTES has sound reliability and support for its use in determining whether people with schizophrenia make real improvements in behavior that affects occupational performance over time.

Importance: Designing, implementing, and measuring the effectiveness of sustainable Internationalization at Home programs will support the development of cultural competence among occupational therapy students.

Objective: To explore potential sustainable, effective methods for enhancing cultural competence in occupational therapy students through cross-cultural online collaborations.

Design: Pretest–posttest, parallel mixed-methods design.

Setting: An online collaboration using video conferencing technology and classrooms at the European University Cyprus and the University of St. Augustine for Health Sciences.

Participants: Bachelor of science and master of occupational therapy students at the European University Cyprus and the University of St. Augustine for Health Sciences, respectively.

Intervention: Online video conferencing collaboration between occupational therapy students in which students discussed their perspectives and experiences regarding social injustice and occupational therapy’s role in working with vulnerable populations.

Outcomes and Measures: Each campus participated in focus groups, and students completed individual reflections. Themes were derived from the qualitative information gathered. Quantitative data were collected using the Cultural Awareness Scale for Occupational Therapy Students (CASOTS).

Results: CASOTS did not reflect changes in cultural awareness. The qualitative measures identified students’ desire to participate in more frequent and culturally diverse experiences. Challenges included length of preparation and actual communication time. Inclusion of prior asynchronous sessions and methods to overcome the language barrier was suggested for future implementation.

Conclusion: Synchronous cross-cultural collaborations may enhance occupational therapy student’s cultural awareness and may be more attractive than traditional in-class teaching. Further development is necessary to overcome challenges.

What This Article Adds: Documenting the benefits and barriers of implementing Internationalization at Home experiences will allow academic institutions to create sustainable methods for enhancing occupational therapy students’ cultural competence. Recommendations to further enhance Internationalization at Home experiences provide opportunities for increased cultural collaboration.

Importance: The Intentional Relationship Model (IRM) guides learning about therapeutic use of self. The observer version of the Clinical Assessment of Modes (CAM–Observer) may be used to evaluate students’ therapeutic communication as the process is defined in the IRM.

Objective: To assess the structural validity of the CAM–Observer.

Design: Cross-sectional, psychometric study.

Setting: Master’s in occupational therapy program.

Participants: One hundred thirty-four entry-level students.

Outcomes and Measures: The overall CAM–Observer and the individual subscales (Advocating, Collaborating, Empathizing, Encouraging, Instructing, Problem-Solving) were used to assess students’ communication from the instructor’s perspective.

Results: The overall CAM–Observer and six subscales demonstrated appropriate rating scale functioning and dimensionality. The Advocating subscale demonstrated poor item fit, floor effects, and low person separation. One Collaborating item demonstrated poor fit to the overall CAM–Observer and the Collaborating subscale, requiring revision. Instructing and Encouraging items were most likely to be endorsed by the instructor–observers, resulting in a ceiling effect for the Instructing and Encouraging subscales. The Advocating and Problem-Solving items were least likely to be endorsed by the instructor–observers. Except for the Problem-Solving subscale, the overall CAM–Observer and the individual subscales could reliably separate items according to difficulty. Except for the Advocating subscale, the overall CAM–Observer and the individual subscales could reliably separate people into high- and low-performance groups.

Conclusions and Relevance: The CAM–Observer offers a structurally valid and theoretically grounded assessment of students’ therapeutic communication as the process is defined in the IRM. The CAM–Observer can be integrated into occupational therapy education to guide students’ critical reflection on their interpersonal communication.

What This Article Adds: The CAM–Observer offers a means of evaluating students’ therapeutic use of self.

Importance: Autistic adults face decreased community participation for employment, education, and social activities plus barriers to driving and transportation. However, little is known about their experiences of moving around community environments.

Objective: To explore contextual issues and experiences of independent community mobility and driving for autistic adults and to determine the modes of community mobility, regions studied, and methodologies used.

Data Sources: Seven databases were searched from 2000 to 2019. All empirical research relating to autism, community mobility, and driving for people older than age 5 yr was mapped. Studies examining experiences of community mobility and driving were selected for scoping review.

Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews methodology was used. Thirteen studies reporting specifically on autistic adults’ experiences with public transportation, driving, and pedestrian navigation of community environments were included. These studies were analyzed using concepts from the Person–Environment–Occupation–Performance Model.

Findings: Nine studies examined experiences of autistic adults. Seven studies explored proxy perspectives. Those studies examining driving primarily focused on learner driver experiences. Although most studies reported on personal and environmental factors, some studies reported on broader social communication and personal narrative factors. None used inclusive methodology involving autistic adults.

Conclusions and Relevance: A broader focus on the contextual experiences of community mobility and driving is needed to support participation of autistic adults in their communities. Linking community mobility experiences with participation outcomes and expanding research to include experienced drivers and nonurban populations is an important component of this work.

What This Article Adds: Occupational therapy interventions should address community mobility and driving skills before school transition. Autistic adults’ skill development may be affected by person factors such as motivation, anxiety, social skills, communication, and occupational performance desires. Environmental factors such as parental concerns, community safety, pedestrian environments, traffic volume, and public transportation design are important. Further research partnering with autistic adults could better inform future occupational therapy interventions for community mobility and driving.

Importance: Given the importance of proprioception in motor coordination, the identification of sensory deficits contributing to motor challenges is crucial for appropriate intervention; however, objective proprioceptive tests are not currently available in pediatric clinical practice.

Objective: To pilot test methods for assessing proprioception in children. Children with somatodyspraxia were predicted to have reduced proprioceptive awareness compared with age-matched control children.

Design: Observational study.

Setting: Individual clinic.

Participants: Ten children identified as having somatodyspraxia and 10 typically developing children, ages 6–8 yr.

Outcomes and Measures: Spatial awareness and force perception were assessed by having the children match arm positions and grip and pinch forces using electronic dynamometers.

Results: All children were able to complete the proprioceptive assessments. Of those identified as having somatodyspraxia, 90% showed deficits in at least one area of proprioception. Children with somatodyspraxia performed more poorly on spatial awareness and force perception tests than typically developing children (p < .05).

Conclusions and Relevance: Children with dyspraxia have difficulties with spatial awareness and force perception, confirming a somatosensory contribution to dyspraxia.

What This Article Adds: This article presents a framework and methods to measure proprioception in children. These methods will allow occupational therapy practitioners to quantify the proprioceptive deficits common in children with dyspraxia.

Occupational therapy practitioners provide interventions to promote activity engagement to multiple clinical populations. They help clients develop restorative, adaptive, and compensatory skills to improve their performance in daily activities. The issue addressed in this article is that current clinical frameworks lack translation of learned skills to consistent everyday performance. There is a gap between what clients can do and what clients actually do in everyday life. Behavioral activation provides an explicit, structured, and practical approach that can translate capacity into long-term engagement. This article presents behavioral activation as a transdiagnostic approach that targets populations experiencing chronic illness to bridge the gap between what the client can do in therapy and what the client could do in everyday life.

What This Article Adds: People with chronic illness have difficulty translating the skills learned in traditional practice settings to everyday life. Behavioral activation offers occupational therapy practitioners a practical structure to promote the translation of learned skills.

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. This article presents a case example of a young child with autism spectrum disorder who receives occupational therapy evaluation and intervention in natural environments (home and child care center). Systematic review findings supporting enhancement of key life occupations through interventions to develop cognitive, motor, social–emotional, and self-care skills for young children were published in AOTA’s Occupational Therapy Practice Guidelines for Early Childhood: Birth–5 Years (Frolek Clark & Kingsley, 2020) and the March/April 2020 issue of the American Journal of Occupational Therapy (Gronski & Doherty, 2020; Kingsley et al., 2020; Tanner et al., 2020). Each article in the Evidence Connection series applies evidence from the published reviews on a topic to a related case. These articles are designed to promote application of the evidence to practice.