American Journal of Occupational Therapy

Lung cancer claims more lives than any other cancer in the world and remains difficult to diagnose in the early stages. This article examines the current state of lung cancer detection and screening via low-dose computed tomography (LDCT) in Alaska and considers potential opportunities for occupational therapy practitioners in primary care settings. Medicare requires at least one documented shared decision-making encounter between provider and patient before LDCT lung cancer screening occurs. As a result of time constraints, documentation requirements, and the plethora of preventive health services they provide, primary care physicians often lack the time and training to conduct this essential service. This provides an opportunity for occupational therapy practitioners to perform these services as part of their practice and to play a role in this area as patient educators and prevention specialists in primary care settings.

What This Article Adds: This article explores the national health crisis of lung cancer and describes how occupational therapists can participate in providing care in primary care settings.

Occupational therapy practitioners have a unique opportunity to participate as lung cancer screening educators, prevention specialists, and policy advocates within primary care teams.

The neurodiversity movement presents a significant opportunity for occupational therapy practitioners to meet the needs of neurodivergent people across the life course The term neurodiverse includes autistic people and people with intellectual disabilities, attention deficit hyperactivity disorder, obsessive–compulsive disorder, and several other mental health conditions. Research shows that neurodivergent people continue to need occupational therapy beyond the end of high school, when most supports and services end for them. Despite research showing that the needs of neurodiverse populations continue throughout the life course, research also shows that services for this population seem to taper as they progress through the public school system. The studies in this issue add to the body of literature supporting the role of occupational therapy practitioners in meeting the needs of neurodiverse people for services and supports through all stages of life.

The studies in this special issue show the need for enhanced practices, supports, and services through occupational therapy for neurodiverse people through all stages of life.

Importance: Occupational therapy practitioners use a range of habilitative and compensatory approaches to teach new skills or modify tasks and environments to address occupational performance among adults with intellectual disability (ID); therefore, they must identify and use available evidence to guide intervention planning.

Objective: To summarize the scope of evidence that can inform occupational therapy intervention with adults with primary or comorbid ID.

Data Sources: Articles published in peer-reviewed journals between January 2002 and January 2018 and indexed in PubMed, CINAHL, PsycINFO, and Scopus.

Study Selection and Data Collection: A total of 159 articles met inclusion criteria and contained information on occupational therapy intervention with adults ages 18 yr or older with primary or coexisting ID.

Findings: Fifty-seven of the 159 articles focused on intervention to address occupational performance outcomes (i.e., employment, self-care, leisure and social interaction, community participation).

Conclusions and Relevance: A wide range of literature is available to support occupational therapy intervention with adults with ID. Occupational therapy practitioners may be less knowledgeable about this evidence because much of it is located in non–occupational therapy or international journals.

What This Article Adds: This scoping review provides occupational therapy practitioners with evidence to support high-quality occupational therapy intervention with adults with ID.

A wide range of literature, much of it in non–occupational therapy or international journals, is available to support occupational therapy intervention with adults with ID.

Importance: Understanding occupational therapy practice patterns for adolescents who have autism spectrum disorder (ASD) provides a baseline to determine areas of need and effective interventions.

Objective: To identify puberty-related challenges addressed and interventions used by occupational therapy practitioners with adolescents ages 8–16 yr with ASD.

Design: A nonexperimental survey design with a stratified random sample was used.

Setting: The Occupational Therapy–Autism and Puberty Survey was distributed in the United States online through the Qualtrics platform (available October 2017–January 2018).

Participants: Occupational therapists (89%) or occupational therapy assistants with experience with adolescents who have ASD were included. The 71 eligible respondents were primarily White women with an average 16 yr of experience.

Outcomes and Measures: Nine key challenges and 11 interventions regarding puberty and ASD were identified. Hypotheses were generated before data collection.

Results: More practitioners (>47%) addressed emotional regulation and personal hygiene, and fewer (<26%) addressed menstruation, safety, and masturbation. Nearly all practitioners (>92%) reported using social learning approaches and behavioral strategies, and most (>80%) reporting having received education in these interventions. Significant differences were found between reported education and use of behavioral skills training incorporating applied behavioral analysis (p < .001), parent training (p = .002), and technology (p = .003).

Conclusions and Relevance: Practitioners are neglecting to address puberty-specific challenges with adolescents who have ASD. Opportunities exist to expand the interventions used and challenges addressed by occupational therapy practitioners for adolescents with ASD.

What This Article Adds: This article expands occupational therapy literature by giving a baseline understanding of the puberty-related challenges that practitioners are addressing with adolescents who have ASD. This information can assist the profession in developing effective interventions and educational opportunities to allow practitioners to successfully address puberty-specific challenges.

Opportunities exist to expand the interventions used in occupational therapy to successfully address puberty-specific challenges among adolescents with ASD.

Importance: Occupational therapy practitioners should use evidence-based practices, such as video modeling, to address work occupations supporting people with autism spectrum disorder, including those with co-occurring intellectual and developmental disabilities.

Objective: To examine the evidence and relevance of video modeling supporting engagement in work occupations for people with autism and to translate these findings to occupational therapy practice.

Data Sources: Cochrane Collection Plus, CINAHL, PubMed, ERIC, ProQuest, and peer-reviewed occupational therapy literature from 2008 to 2018.

Study Selection and Data Collection: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study selection and data collection focused on occupational therapy scope of practice, autism spectrum disorder, co-occurring intellectual and developmental disabilities, video modeling, and work occupations for people age 16 yr and older.

Findings: A total of 464 articles were screened. Six articles met inclusion criteria. Results indicated moderate evidence for video modeling to support work occupations for people with autism, specifically employment seeking and acquisition and specific job-performance skills. Samples were limited to people younger than age 28 yr and represented varied intellectual abilities, indicating potential for benefits across the spectrum of cognitive functioning.

Conclusions and Relevance: This systematic review highlights the promising potential of video modeling to address work occupations for people with autism. However, more rigorous effectiveness research is needed, including studies by occupational therapy practitioners.

What This Article Adds: Occupational therapy expertise paired with video modeling, as a strengths-based, client-centered, customizable, socially acceptable intervention, can provide meaningful support for work occupations.

Occupational therapy expertise paired with video modeling can provide meaningful support to work occupations.

Importance: Occupational therapy practitioners should understand the barriers faced by young adults with intellectual and developmental disabilities (IDD) who are attempting a successful transition to postsecondary work, higher education, community and social activities, and living opportunities so they can better advocate for them and tailor their involvement in the transition process.

Objective: To explore the lived experience of parents of adolescents with IDD participating in the transition process.

Design: Phenomenological design.

Setting: Community-based setting with interviews occurring face-to-face in the participants’ home or via telephone.

Participants: Eleven parents of adolescents and young adults (ages 16–22 yr) with IDD.

Outcomes and Measures: Semistructured interviews focusing on parent and family experiences with the transition process.

Results: Seven themes emerged from the data representing parent perceptions related to the use or lack of person-centered practices, needing more communication from the team, frustration with being the driving force of progress, feelings of defeat, gaps between programming options, positive team collaboration, and planning for the future.

Conclusions and Relevance: Parents identified person-centered planning, guidance from school staff, and resource sharing as desired practices in the transition planning process. The outcomes indicate that some aspects of the transition process have not changed in several decades.

What This Article Adds: Occupational therapy practitioners are optimally positioned to remediate transition issues; therefore, it is essential that they assert their integral role in the transition planning process to increase self-determination and quality of life for all adolescents and young adults with IDD.

Occupational therapy practitioners are optimally positioned to remediate transition issues and must assert their role in transition planning for youth with IDD.

Importance: The occupational goal intervention (OGI) method has been proven effective in improving executive function (EF) in people with schizophrenia, but it has not yet been tested with those with treatment-resistant schizophrenia (TRS).

Objective: To test the efficacy of the OGI in people with TRS.

Design: Single-blind randomized controlled trial.

Setting: The Schizophrenia Program, Institute of Psychiatry, University of São Paulo General Hospital, Brazil.

Participants: People with TRS according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria, ages 18 to 55.

Outcomes and Measures: Primary outcome: improvement in EF as measured by the Behavioural Assessment of the Dysexecutive Syndrome (BADS). Secondary outcomes: improvement of functionality, as measured by the Direct Assessment of Functional Status–Revised (DAFS–BR), and improvement in autonomy in activities of daily living (ADLs), as measured by the Independent Living Skills Survey (ILSS–BR), administered to caregivers. The outcomes were measured at baseline, posttreatment, and follow-up.

Intervention: Participants were divided into two groups: OGI and craft activities (control). Each group participated in 30 sessions during 15 wk, with follow-up at 6 mo postintervention.

Results: The OGI group improved significantly compared with the control group, with medium to large effect sizes in posttreatment scores on the BADS and DAFS–BR. The ILSS–BR showed the highest effect sizes at posttreatment and follow-up.

Conclusions and Relevance: The OGI method is effective for improving EF, occupational performance and ADLs in people with TRS.

What This Article Adds: The OGI method is an important therapeutic tool for use in the occupational therapy clinic.

The occupational goal intervention method was found to be effective in improving executive function, occupational performance, and ADLs in people with TRS.

Importance: People with intellectual and developmental disabilities (IDD) express a clear interest in intimate relationships but face many barriers to receiving sex education (SE) that would support their engagement in these relationships.

Objective: To understand barriers to, the context of, and recommendations for SE for people with IDD.

Design: Qualitative study design with interviews and focus groups with four key stakeholder groups. Data were analyzed using a constant comparative approach.

Participants: Participants were 8 youths with IDD, 9 parents, 12 health care providers, and 8 educators.

Results: Four barriers to SE were identified: (1) values and cultural issues, (2) parental attitudes toward their child’s sexuality, (3) a lack of organizational policies and standards, and (4) limited professional education or societal biases. These barriers contribute to a SE context primarily initiated by people with IDD or provided reactively. The participants recommended proactive, formal SE provided by multiple stakeholders throughout adulthood.

Conclusions and Relevance: Stakeholders should advocate for policies, standards, and additional training for parents, educators, and health care providers to support SE for people with IDD throughout adulthood.

What This Article Adds: Barriers to SE contribute to the current context in which SE is shared with people with IDD. Stakeholders can advocate for policies, standards, and training to overcome these barriers and support recommendations for proactive, formal SE provided by multiple stakeholders through adulthood.

Stakeholders can advocate for policies, standards, and additional training to support proactive, formal SE throughout adulthood for people with IDD.

Importance: Parents play an essential role in the transition to adulthood for autistic youth, yet often feel they do not have adequate training and resources.

Objective: To evaluate data on the preliminary efficacy of and collect participant feedback about the Maximizing Adolescent Post-Secondary Success (MAPSS) intervention.

Design: Single-group, pretest–posttest pilot study.

Setting: Clinic.

Participants: Twenty-two families of autistic youth (ages 13–19 yr, 72.7% male).

Intervention: MAPSS is a group intervention for parent–youth dyads that is designed to guide parents in facilitating the development of independent skills for adulthood.

Outcomes and Measures: Measures included the Transition Preparation Activities Measure (T-PAM), Family Empowerment Scale (FES), 10-item Perceived Stress Scale (PSS–10), Adulthood Expectations Questionnaire (AEQ), Adaptive Behavior Assessment System–Third Edition (ABAS–3), and a study-specific participant feedback survey.

Results: Frequency of transition preparation activities (T-PAM) significantly increased from before to after the intervention, and although the frequency of preparation activities decreased by 1-mo follow-up, it remained significantly higher than at baseline. Parent self-efficacy (FES), parent expectations (AEQ), and parent sense of control over outcomes (AEQ) also significantly increased from preintervention to follow-up; however, parent coping (PSS–10) was unchanged. Youth self-care skills (ABAS–3) demonstrated improvements 6 mo after the completion of the intervention, although other areas of adaptive behavior did not significantly change. Feedback from parents suggested they had positive experiences and felt the intervention was beneficial.

Conclusions and Relevance: Our data suggest that the MAPSS intervention is an appropriate candidate for larger, controlled clinical trials.

What This Article Adds: With additional evidence, this intervention can offer guidelines for occupational therapists to work with autistic youth and their parents to prepare for adulthood.

The MAPSS intervention can offer guidelines for occupational therapists working with autistic youth and their parents to prepare for adulthood

Importance: The number of adults with intellectual and developmental disabilities (IDD) seeking treatment in non–IDD-specific health care settings is growing. Little is known about how adults with IDD use health care services in specialty settings, including occupational therapy services.

Objective: To describe adults with IDD in hospitals and identify differences in utilization patterns compared with patients without IDD.

Design: Descriptive and correlational designs were used.

Participants: Data were obtained from Vizient (Clinical Data Base/Resource Manager™), a national database of administrative discharge abstracts for adults admitted to hospitals for an orthopedic procedure. From this sample, subsamples of (1) patients diagnosed with IDD and (2) an age- and gender-matched sample of patients without IDD were identified.

Results: The study cohort with IDD experienced longer lengths of stay, t(2821.5) = −14.2, p < .001; were more likely to have Medicare coverage, χ²(3, N = 8,472) = 1,170.38, p < .001; and were more commonly discharged to subacute or skilled nursing facilities, χ²(5, N = 8,472) = 1,033.60, p < .001. Differences in occupational therapy services were also noted.

Conclusions and Relevance: Despite similarities in orthopedic procedures, participants with IDD had different use patterns than those without IDD. Differences may be attributed to varying client factors and contexts. The results also indicate that practitioners in non–IDD-specific settings should expect to encounter clients with IDD. Occupational therapy practitioners have an opportunity to be leaders in adapting treatment protocols and providing education to caregivers and health care providers on behalf of people with IDD.

What This Article Adds: This article provides novel information about a population that is known to experience disparities in health outcomes. It offers a basis on which future research can build to improve health care delivery and occupational therapy interventions to improve outcomes.

Differences in utilization patterns for patients with IDD provide a basis for occupational therapy practitioners to be leaders in adapting treatment protocols and providing education to caregivers and health care providers.

Importance: Quality of life (QoL) is a core outcome of occupational therapy, but it is decreased among autistic adolescents and adults. This is the first review of QoL from an occupational therapy standpoint.

Objective: To identify self-reported QoL differences between autistic and nonautistic samples; investigate sex differences in QoL among autistic people; examine consistency in QoL among autistic people across age, intellectual disability (ID), and self- versus proxy-report method; and appraise occupational therapy–related interventions addressing QoL among autistic people.

Data Sources: Articles published in peer-reviewed journals between 2010 and 2020, located through Academic Search Ultimate, PubMed, and OTseeker, along with the American Journal of Occupational Therapy, British Journal of Occupational Therapy, Canadian Journal of Occupational Therapy, and Australian Occupational Therapy Journal.

Study Selection and Data Collection: Article samples consisted of at least 20% autistic females and used self-reported QoL measures. Qualitative research was excluded, as well as studies with participants younger than age 13 yr. Twenty-seven articles qualified (3 Level 1B, 13 Level 3B, and 11 Level 4).

Findings: Autistic adolescents and adults demonstrated decreased self-reported QoL compared with nonautistic peers across age and ID presence. One article compared sex differences in QoL among autistic people. Interventions improved QoL among autistic people.

Conclusions and Relevance: Autistic adolescents and adults demonstrate decreased QoL in comparison with nonautistic peers. Questions remain related to sex differences in QoL among autistic people, an area for future research. Multiple evidence-based approaches to improve QoL in the autistic population are relevant to occupational therapy practice.

What This Article Adds: Self-reported QoL among autistic adolescents and adults is clearly lower than among their nonautistic counterparts. This article provides information on multiple interventions related to occupational therapy to improve QoL among autistic people.

This article provides information on multiple interventions related to occupational therapy to improve QoL among autistic people.

Importance: Occupational therapy practitioners use structured assessment tools to gather information from adults with intellectual disability (ID) in order to develop the occupational profile, guide occupational therapy intervention, and assess change over time.

Objective: To identify occupational therapy–related tools in the peer-reviewed literature for use in practice with adults with ID.

Data Sources: Peer-reviewed literature published between January 2002 and January 2018 included in CINAHL, PsycINFO, PubMed, and Scopus.

Study Selection and Data Collection: The review included articles that had information on occupational therapy–related assessment with adults 18 yr or older who had primary or co-occurring ID.

Findings: Fifty-eight articles identified 73 occupational therapy–related assessment tools.

Conclusions and Relevance: This scoping review identified a broad range of assessment tools in the occupational therapy domain that are appropriate for adults with ID, some of which may be unfamiliar to occupational therapy practitioners.

What This Article Adds: This scoping review provides occupational therapy practitioners with a summary of occupational therapy–related assessment tools for adults with ID and an assessment reference guide.

This scoping review provides occupational therapy practitioners with a summary of occupational therapy–related assessment tools for adults with ID and an assessment reference guide.

Importance: In the transition to adulthood, driving supports independence. For autistic adolescents, training provided by specialized driving instructors, including occupational therapists, may establish fitness to drive and continued independence.

Objective: To examine specialized driving instructors’ experiences providing behind-the-wheel instruction to autistic adolescents.

Design: We recruited participants through purposive and snowball sampling of members of ADED, the Association for Driver Rehabilitation Specialists. Interviews investigated experiences providing instruction, autistic students’ strengths and challenges, strategies used, and recommendations to improve the learning-to-drive process. We coded transcripts using a directed content analysis approach.

Setting: Telephone interviews.

Participants: Specialized driving instructors (N = 17) trained as occupational therapists, driver rehabilitation specialists, or licensed driving instructors with recent experience providing behind-the-wheel training for autistic adolescents participated.

Results: Behind-the-wheel challenges included mental inflexibility, distractibility, and difficulties with social cues and motor coordination. Instructors acknowledged students’ strengths, including adherence to rules of the road, limited risk taking, and careful observations. Instructors scaffolded learning to help students develop skills. Although licensure and driving outcomes were sometimes unknown to instructors, students who became licensed frequently drove with supervision or restrictions.

Conclusions and Relevance: Licensure is possible for autistic adolescents, although developing fitness to drive requires individualization and rigorous specialized instruction, which may culminate in delayed or restricted driving.

What This Article Adds: This article highlights challenges and strengths encountered by specialized driving instructors teaching autistic adolescents. Despite requiring prolonged training, autistic adolescents can achieve licensure when supported by specialized instruction that is individualized to their needs and strengths.

Autistic adolescents can achieve licensure when supported by specialized, prolonged instruction that is individualized to their needs and strengths

Importance: Caregivers play a critical role in facilitating the performance of people with Parkinson’s disease (PD). Knowledge on how occupational therapy practitioners can mitigate the negative effects of caregiving is needed to enable caregiver participation.

Objective: To explore the effectiveness of interventions within the scope of occupational therapy practice for caregivers of people with PD to facilitate or maintain their participation in the caregiver role.

Data Sources: We conducted a systematic review of the literature published in CINAHL, MEDLINE, PsycINFO, and OTseeker between 2011 and 2019. Article reference lists were also hand searched for additional articles.

Study Selection and Data Collection: Articles were screened and evaluated using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The review was conducted in accordance with steps outlined by the American Occupational Therapy Association’s Evidence-Based Practice Project.

Findings: Six articles met the inclusion criteria. Interventions in each article were distinct, prohibiting theme development. Overall, the strength of evidence was low, and the risk of bias was high. None of the studies included in this review were obtained from the occupational therapy literature.

Conclusions and Relevance: Little evidence is available to support interventions within the scope of occupational therapy practice for caregivers of people with PD. Existing evidence suggests that interventions need to be flexible (e.g., in terms of time, cost, and delivery method) and tailored to the unique needs of this population.

What This Article Adds: There is a continued need to develop occupational therapy interventions that support participation in the caregiving role for caregivers of people with PD.

An evaluation of existing evidence for supporting caregivers of people with Parkinson’s disease highlights the need for continued research in this area.

Importance: People with Parkinson’s disease (PD) commonly experience difficulty in performing activities of daily living (ADLs), which affects their perceived quality of life.

Objective: To examine the evidence for the effectiveness of interventions within the scope of occupational therapy to improve performance and participation in ADLs, rest, and sleep in adults with PD.

Data Sources: Databases searched were MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane Collection. Included articles were published between January 2011 and December 2018.

Study Selection and Data Collection: Articles describing Level 1b, 2b, and 3b studies that examined outcomes related to ADLs, rest, and sleep in people with PD were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Findings: Forty-five articles (10 Level 1b, 27 Level 2b, and 8 Level 3b) met the inclusion criteria.

Conclusions and Relevance: Strong strength of evidence was found to support inpatient multidisciplinary intensive rehabilitation treatment (MIRT) to improve ADLs, and moderate strength of evidence that MIRT improves sleep performance. Low strength of evidence was present for outpatient occupational therapy to improve ADL and sleep outcomes. Low strength of evidence was found for resistance exercise programs to improve ADLs, but moderate strength of evidence indicates that multimodal exercise programs and targeted exercise programs can improve ADLs. Low to moderate strength of evidence suggested that alternative therapies and cognitive–behavioral therapy have a positive impact on ADLs and sleep. These results can be used to inform evidence-based occupational therapy practice.

What This Article Adds: This article provides information for practitioners on the effectiveness of interventions within the scope of occupational therapy practice to improve ADLs and sleep.

A review of the current literature identifies evidence-based interventions within the scope of occupational therapy practice to improve ADLs and sleep for people with PD

Importance: Instrumental activities of daily living (IADLs) are important for independence, safety, and productivity, and people with Parkinson’s disease (PD) can experience IADL limitations. Occupational therapy practitioners should address IADLs with their clients with PD.

Objective: To systematically review the evidence for the effectiveness of occupational therapy interventions to improve or maintain IADL function in adults with PD.

Data Sources: MEDLINE, CINAHL, PsycINFO, OTseeker, and Cochrane databases from January 2011 to December 2018.

Study Selection and Data Collection: Primary inclusion criteria were peer-reviewed journal articles describing Level 1–3 studies that tested the effect of an intervention within the scope of occupational therapy on an IADL outcome in people with PD. Three reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Findings: Twenty-two studies met the inclusion criteria and were categorized into four themes on the basis of primary focus or type of intervention: physical activity, specific IADL-focused, cognitive rehabilitation, and individualized occupational therapy interventions. There were 9 Level 1b, 9 Level 2b, and 4 Level 3b studies. Strong strength of evidence was found for the beneficial effect of occupational therapy–related interventions for physical activity levels and handwriting, moderate strength of evidence for IADL participation and medication adherence, and low strength of evidence for cognitive rehabilitation.

Conclusions and Relevance: Occupational therapy interventions can improve health management and maintenance (i.e., physical activity levels, medication management), handwriting, and IADL participation for people with PD. Further research is needed on cognitive rehabilitation. This review is limited by the small number of studies that specifically addressed IADL function in treatment and as an outcome.

What This Article Adds: Occupational therapy intervention can be effective in improving or maintaining IADL performance and participation in people with PD. Occupational therapy practitioners can address IADL function through physical activity interventions, interventions targeting handwriting and medication adherence, and individualized occupational therapy interventions.

Occupational therapy intervention can be effective in improving or maintaining physical activity levels, medication management, handwriting, and IADLs for people with PD.

Importance: Falls have a considerable physical and psychological impact on people with spinal cord injury (SCI). Occupational therapy practitioners require evidence to support the timely development of occupation-based programs that can be applied to fall prevention in daily life.

Objective: To determine what is known about falls after SCI, including wheelchair users and people who are ambulatory, and to understand elements of fall prevention to be addressed by occupational therapy practitioners. We applied the Canadian Measure of Occupational Performance and Engagement to understand elements to be addressed in fall education and prevention with this population.

Data Sources: We searched eight databases using the key words falls and spinal cord injury with no limit set on dates.

Study Selection and Data Collection: Studies were included that reported on falls among adults with SCI and measured one or more of the following: incidence of falls, consequences of falls, contributing factors for falls, the person’s experience of falls, and strategies to prevent falls.

Findings: Thirty-five articles were included. The majority of the articles included information on the incidence (n = 20), consequences (n = 26), and contributing factors (n = 30) of falls. Two articles analyzed the person’s experience of falls, and 1 study reviewed a fall prevention program for people with SCI specifically.

Conclusions and Relevance: Research on participants’ experience of falls and fall prevention programs used in spinal cord rehabilitation is extremely limited. Future research on the lived experience of falls for people with SCI is warranted.

What This Article Adds: This review of evidence on falls after SCI highlights gaps in the current available evidence.

This review of research on participants’ experience of falls and fall prevention programs used in spinal cord rehabilitation highlights gaps in the available evidence.

Importance: Incivility in health care settings has detrimental effects on practitioners’ well-being, patient outcomes, and health care costs.

Objective: To explore the prevalence and types of perceived incivility experienced by occupational therapy practitioners in their workplaces and the relationships between perceived incivility and practitioner demographics.

Design: Cross-sectional, online survey.

Setting: Surveys were posted to occupational therapy social media sites.

Participants: Occupational therapy practitioners throughout the United States.

Outcomes and Measures: The Negative Acts Questionnaire–Revised (NAQ–R) was used to measure incivility and bullying. Participants answered demographic questions, and one-way analyses of variance and t tests were used to examine differences between demographic characteristics and mean scores on the NAQ–R.

Results: A total of 1,320 practitioners completed the survey. Although the incidence of incivility was low compared with prior research in other health professions, 11% of respondents reported being victims of bullying in the workplace. Practitioners with less experience and who worked in long-term care and skilled nursing settings were more likely to experience incivility, and occupational therapy practitioners experienced significantly less incivility than occupational therapy assistants.

Conclusions and Relevance: Practitioners, colleagues, managers, and organizations must collaborate to foster an environment of civility and respect to mitigate the effects of incivility on patient outcomes, practitioners’ well-being, and health care costs.

What This Article Adds: This survey provides baseline information regarding incivility experienced by occupational therapy practitioners, an important first step in developing evidence-based interventions to promote safe and healthy workplaces.

The finding of incivility in occupational therapy workplaces underscores the importance of developing positive work cultures to ensure the health and safety of clients and practitioners.

Social participation in schools is critical to student academic and psychosocial outcomes. Neurodivergent students, however, often experience environmental barriers to social participation, such as lack of awareness and negative attitudes among peers and school staff, including teachers. Although authentic social participation is composed of dynamic interactions between a person and the external environments, occupational therapy’s role in addressing student social participation primarily focuses on internal social characteristics. Barriers within school environments often remain unaddressed, with no clear role for occupational therapy practitioners. We advocate an expansion of occupational therapy’s role to address school environments, especially the social, physical, and policy aspects, to promote social participation and inclusion. We also discuss the need for change and present a framework guiding intervention in school environments.

Occupational therapy practitioners can facilitate the social participation and inclusion of neurodivergent students in schools by shifting the focus to addressing environmental barriers.

Now more than ever, the lack of racial and ethnic diversity must be addressed within the health care system, specifically in occupational therapy. This change starts with the successful completion of educational programs by underrepresented minority (URM) occupational therapy students. To increase diversity in the profession, accrediting bodies should mandate support for students of all backgrounds to be successful in higher education. As addressed in the American Occupational Therapy Association 2020 Code of Ethics, the Vision 2025 statement and its pillars, current knowledge on health disparities and occupational therapy demographic data, and other health professional programs’ accreditation standards, there is a need for an addition to, or revision of, the Accreditation Council for Occupational Therapy Education (ACOTE^®) standards to support the recruitment and retention of URM occupational therapy students.

What This Article Adds: This column provides an evidence-based rationale to address the need for an ACOTE standard requiring documented efforts to support racial and ethnic diversity within occupational therapy education.

The authors provide a rationale for an ACOTE® standard requiring support for the recruitment and retention of underrepresented minority occupational therapy students.