American Journal of Occupational Therapy

Replication and application of research in clinical practice require that interventions be described in detail by the producers of that research. Lack of treatment specificity in publications is thought to contribute to the nearly 17-yr gap between the publication and clinical implementation of best practices. In this editorial I explore a means of addressing this problem in the Rehabilitation Treatment Specification System (RTSS) and present an application of the RTSS to sensory integration intervention.

The interprofessional Rehabilitation Treatment Specification System (RTSS) has great potential for reporting in a way that helps bridge the gap between research and practice, and while there are challenges to its implementation and widespread adoption that are currently being addressed, the American Journal of Occupational Therapy encourages authors to consider using RTSS components when describing rehabilitation interventions.

Occupational therapy practitioners are uniquely qualified and positioned to offer both preventive and rehabilitative models of care. However, the status quo of current reimbursement models has created a barrier to occupational therapy practitioners receiving adequate reimbursement, if any, for doing health promotion and lifestyle-focused work. In this Health Policy Perspectives article, we emphasize the need for reimbursement and propose pathways for new and perhaps untapped or underutilized models of reimbursement for occupational therapy practitioners. These pathways require education and advocacy efforts to showcase our distinct value as key reimbursable and interdisciplinary players in lifestyle medicine and health promotion work.

In this Health Policy Perspectives article, we emphasize the need for reimbursement and propose pathways for new and perhaps untapped or underutilized models of reimbursement for occupational therapy practitioners.

Importance: Handwriting and the fine motor control (hand and fingers) underlying it are key indicators of numerous motor disorders, especially among children. However, current assessment methods are expensive, slow, and subjective, leading to a lack of knowledge about the relationship between handwriting and motor control.

Objective: To develop and validate the iPad precision drawing app Standardized Tracing Evaluation and Grapheme Assessment (STEGA) to enable rapid quantitative assessment of fine motor control and handwriting.

Design: Cross-sectional, single-arm observational study.

Setting: Academic research institution.

Participants: Fifty-seven typically developing right-handed children ages 9 to 12 yr with knowledge of cursive.

Outcomes and Measures: Predicted quality, measured as the correlation between handwriting letter legibility (Evaluation Tool of Children’s Handwriting–Cursive [ETCH–C]) and predicted legibility (calculated from STEGA’s 120 Hz, nine-variable data).

Results: STEGA successfully predicted handwriting (r ² = .437, p < .001) using a support vector regression method. Angular error was the most important aspect of STEGA performance. STEGA was much faster to administer than the ETCH–C (M = 6.7 min, SD = 1.3, versus M = 19.7 min, SD = 5.2).

Conclusions and Relevance: Assessment of motor control (and especially pen direction control) may provide a meaningful, objective way to assess handwriting. Future studies are needed to validate STEGA with a wider age range, but the initial results indicate that STEGA can provide the first rapid, quantitative, high-resolution, telehealth-capable assessment of the motor control that underpins handwriting.

What This Article Adds: The ability to control pen direction may be the most important motor skill for successful handwriting. STEGA may provide the first criterion standard for the fine motor control skills that underpin handwriting, suitable for rehabilitation research and practice.

The initial results of this study indicate that the iPad precision drawing app Standardized Tracing Evaluation and Grapheme Assessment (STEGA) can provide the first rapid, quantitative, high-resolution, telehealth-capable assessment of the motor control that underpins handwriting.

Importance: Functional cognition is emerging as a professional priority for occupational therapy practice. It is important to understand how it relates to other established cognitive constructs, so that occupational therapists can demonstrate their unique contributions.

Objective: To examine whether functional cognition is a construct that is distinct from crystallized and fluid cognitive abilities.

Design: Secondary analysis of data collected from a cross-sectional study.

Setting: Community.

Participants: Adults with spinal cord injury, traumatic brain injury, or stroke (N = 493).

Outcomes and Measures: The National Institutes of Health Toolbox Cognition Battery and the Executive Function Performance Test.

Results: We used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to investigate the factor structure of cognition. EFA identified three factors representing crystallized, fluid, and functional cognition. CFA revealed a second-order model in which the three cognitive constructs contribute hierarchically to a general cognitive factor.

Conclusions and Relevance: This study provides important and timely evidence for establishing functional cognition as a unique construct that is distinct from executive function as well as from fluid and crystallized cognition. Functional cognition is central to performance in daily activities, and its use will ensure that occupational therapy services support continued recovery and community reintegration.

What This Article Adds: This study supports occupational therapy professionals in establishing the profession’s role in evaluating and treating deficits of functional cognition to support patients’ return to desired occupations in the family, workplace, and community.

This study provides evidence for establishing functional cognition as a unique construct that is distinct from executive function as well as from fluid and crystallized cognition, and supports occupational therapy professionals in establishing the profession’s role in evaluating and treating functional cognition deficits to support patients’ return to desired occupations in the family, workplace, and community.

Importance: The Purdue Pegboard Test (PPT) is widely used as a measure of manual dexterity. Declining manual dexterity may predict cognitive decline among elderly people, but normative data for this population are scarce.

Objective: To identify demographic and clinical predictors of PPT results in normal middle-aged and elderly Austrian people and to provide norms stratified by significant determinants.

Design: A prospective, community-based cohort study using baseline data of participants from two study panels (1991–1994 and 1999–2003).

Setting: Monocentric study

Participants: 1,355 healthy, randomly selected, community-dwelling people ages 40 to 79 yr.

Method: Extensive clinical examination, including completion of the PPT.

Outcomes and Measures: The number of pegs placed within a 30-s time limit on four subtests: using the right hand, left hand, both hands, and assembly (within 60 s), respectively. Demographic outcomes were the highest grade achieved.

Results: For all four subtests, increasing age (βs = −0.400 to −0.118, SEs = 0.006 to 0.019, p < .001) and male sex (βs = −1.440 to −0.807, SEs = 0.107 to 0.325, p < .001) was related to worse test results. Among vascular risk factors, diabetes (βs = −1.577 to −0.419, SEs = 0.165 to 0.503, p < .001) was related to worse test results but explained only a small portion (0.7%–1.1%) of the variability in PPT performance.

Conclusions and Relevance: We provide age- and sex-specific norms of the PPT for a middle-aged and elderly population. The data represent useful reference values when assessing manual dexterity in older age groups.

What This Article Adds: Advancing age and male sex relate to worse performance on the PPT in a community-dwelling cohort without signs and symptoms of neurological disease. Vascular risk factors explain only very little of the variance of test results in our population. Our study adds to the limited age- and sex-specific norms of the PPT among middle-aged and older people.

This study provides age- and sex-specific norms of the Purdue Pegboard Test (PPT) for a middle-aged and elderly population. The data represent useful reference values when assessing manual dexterity in higher age groups.

Importance: The Integrative Medication Self-Management Intervention (IMedS) is a manualized occupational therapy intervention designed to improve adherence to medications. The intervention influences medication adherence and facilitates new medication habits and routines; however, it has not been tested in a community clinical setting.

Objective: To test the efficacy of the IMedS to address medication adherence rates among community-dwelling adults with hypertension (HTN), Type 2 diabetes mellitus (T2DM), or both.

Design: Randomized controlled trial using a pretest–posttest control group design.

Setting: Primary care clinic in a large federally qualified health center.

Participants: Adults with uncontrolled HTN, T2DM, or both.

Intervention: Participants were divided into two groups: The control group received treatment as usual (TAU) per the primary care protocol, and the intervention IMedS group received TAU and the IMedS intervention.

Outcomes and Measures: Primary outcome: seven-item version of the Adherence to Refills and Medication Scale (ARMS–7), pill count, blood pressure, hemoglobin A1c, or all of these.

Results: The proportion of adherent participants increased in both groups, but between groups, changes were not statistically significant. Post hoc comparisons of the results of a mixed analysis of variance for ARMS–7 measurements indicated that the occupational therapy intervention had a unique effect, compared with that for the TAU control group (d_c = 0.65). Effect scores for pill count (d = 0.55) also suggested that the occupational therapy intervention positively affected adherence.

Conclusions and Relevance: Occupational therapists can provide assessment and intervention to positively influence medication adherence in a primary care setting.

What This Article Adds: This article provides a better understanding of the occupational therapist’s role in addressing medication management and adherence on the interdisciplinary primary care medical team.

Occupational therapists can provide assessment using the Integrative Medication Self-Management Intervention (IMedS) to positively influence medication adherence in a primary care setting.

Importance: Bangladesh hosts a large number of Rohingya refugees from Myanmar. Living in refugee camps, the Rohingya refugees face challenges in everyday occupations because of violence, limited opportunities, and corporal punishment by the community.

Objective: To explore how Rohingya refugees experience participation in everyday occupations while living in temporary refugee camps in Bangladesh.

Design: Phenomenological study to describe, understand, and interpret the meanings of life experiences in particularly adverse conditions.

Setting: Rohingya refugee camps in Bangladesh.

Participants: Fifteen purposively selected participants from the camps.

Outcomes and Measures: In-depth semistructured interview, as well as participant and environmental observations. Researchers used line-by-line data analysis to capture quotations and patterns using interpretive phenomenological analysis, which included establishment of initial codes, interpretation, determining selected codes, and categorization.

Results: The research identified four major themes—(1) mental stress, sleep disturbances, and daily occupations; (2) adjustment to inconsistent daily activities; (3) complex relationships and limited social roles that decreased occupational engagement; and (4) involvement in precarious occupations that exacerbated severe health risks—and four subthemes—(1) fragmented family relationships, (2) formation of new relationships to perform social roles, (3) inconvenient and inaccessible living conditions, and (4) continuation of unlawful work to survive.

Conclusions and Relevance: Rohingya refugees should receive comprehensive health and rehabilitative care because of their perilous mental health conditions, precarious occupations, and lack of trustworthy relationships with family and neighbors.

What This Article Adds: Rohingya refugees experience imbalanced, deprived, and maladapted occupations in refugee camps. Suggestions to improve their lived experience with further peer support programs may help them participate in occupation-based rehabilitation services to facilitate their social integration.

Rohingya refugees experience imbalanced, deprived, and maladapted occupations in refugee camps and should have access to comprehensive health and rehabilitative care, including occupation-based services, to facilitate their social integration.

Importance: Preterm infants are at higher risk of motor development abnormalities and sensory processing difficulties. Few studies have examined both movement development and sensory processing in the early months of life, and the results are controversial.

Objective: In this cross-sectional study, we investigated (1) differences in early spontaneous movements and sensory processing between preterm infants born at <32 wk gestation and those born at 32 to 36 wk gestation when they reached corrected (postterm) age 3 to 5 mo and (2) the relationship between early spontaneous movements and sensory processing.

Participants: We included 50 preterm infants born at <32 wk gestation and 61 preterm infants born at 32 to 36 wk gestation.

Outcomes and Measures: We assessed early spontaneous movements, including fidgety movements, using the General Movements Assessment (GMA), which provides the Motor Optimality Score (MOS), and sensory processing using the Infant Sensory Profile–2.

Results: The preterm infants born at <32 wk gestation had lower MOS results (p = .035) and more sensory processing difficulties (p = .006) than those born at 32 to 36 wk gestation. We found no significant relationship between early spontaneous movements and sensory processing (p > .05).

Conclusions and Relevance: Preterm infants born at <32 wk gestation are at increased risk for motor development abnormalities and sensory processing difficulties.

What This Article Adds: Assessment of both motor development and sensory processing can play a crucial role in identifying infants who need early intervention.

Assessment of both motor development and sensory processing can play an essential role in identifying infants who need early intervention, which occupational therapy practitioners can play a crucial role in.

Importance: To fulfill their societal role, occupational therapists need to exist in sufficient supply, be equitably distributed, and meet competency standards. Occupational therapy workforce research is instrumental in reaching these aims, but its global status is unknown.

Objective: To map the volume and nature (topics, methods, geography, funding) of occupational therapy workforce research worldwide.

Data Sources: Six scientific databases (MEDLINE/PubMed, Scopus, CINAHL, Web of Science Core Collection, PDQ–Evidence for Informed Health Policymaking, OTseeker), institutional websites, snowballing, and key informants.

Study Selection and Data Collection: Research articles of any kind were included if they involved data regarding occupational therapists and addressed 1 of 10 predefined workforce research categories. Two reviewers were used throughout study selection. No language or time restrictions applied, but the synthesis excluded publications before 1996. A linear regression examined the publications’ yearly growth.

Findings: Seventy-eight studies met the inclusion criteria, 57 of which had been published since 1996. Although significant (p < .01), annual publication growth was weak (0.07 publications/yr). “Attractiveness and retention” was a common topic (27%), and cross-sectional surveys were frequent study designs (53%). Few studies used inferential statistics (39%), focused on resource-poor countries (11%), used standardized instruments (10%), or tested a hypothesis (2%). Only 30% reported funding; these studies had stronger methodology: 65% used inferential statistics, and just 6% used exploratory cross-sectional surveys.

Conclusions and Relevance: Worldwide occupational therapy workforce research is scant and inequitably distributed, uses suboptimal methods, and is underfunded. Funded studies used stronger methods. Concerted efforts are needed to strengthen occupational therapy workforce research.

What This Article Adds: This review highlights the opportunity to develop a stronger, evidence-based strategy for workforce development and professional advocacy.

This review highlights the opportunity to develop a stronger, evidence-based strategy for occupational therapy workforce development and professional advocacy.

Importance: Research is needed to validate an easy-to-use, functional, evidence-based neurological upper extremity (UE) assessment that requires minimal training.

Objective: To establish convergent validity for the Functional Upper Extremity Levels (FUEL), a function-based upper limb measure, with the Upper Extremity Fugl-Meyer Assessment (UE–FMA), the gold standard assessment of upper limb recovery poststroke.

Design: Retrospective chart review of 292 clients with admission and discharge data for the UE–FMA and the FUEL. Correlation statistics were analyzed to determine a relationship between these assessments.

Setting: Inpatient stroke rehabilitation unit.

Participants: Clients with a stroke diagnosis admitted to the stroke inpatient rehabilitation unit at a rehabilitation hospital between January 2017 and June 2019.

Outcomes and Measures: FUEL (a classification system) and UE–FMA (an impairment-based motor recovery assessment of the upper limb recovery poststroke).

Results: Pearson correlation coefficient yielded a significant positive correlation between the UE–FMA and the FUEL for both initial (r = .929) and discharge (r = .943) scores.

Conclusions and Relevance: Convergent validity of the FUEL is established using the UE–FMA as a comparison. The FUEL can be applied in neurological rehabilitation to provide a clinical picture of a client’s UE function. This research supports the value of the FUEL’s application in clinical poststroke care.

What This Article Adds: The FUEL is a valid tool to assess the UE in an acute neurological population.

Using the Upper Extremity Fugl-Meyer Assessment (UE–FMA) as a comparison, the Functional Upper Extremity Levels (FUEL) is a valid tool to assess the upper extremity in an acute neurological population and supports the value of the FUEL’s application in clinical poststroke care.

Importance: Guidance is limited for training protocols that support stakeholders who are new to participating in telerehabilitation interventions using videoconferencing software.

Objective: To explore stakeholders’ experiences participating in a group-based intervention during the coronavirus disease 2019 (COVID-19) pandemic using a videoconferencing software (Zoom).

Design: Ad hoc exploratory thematic analysis.

Setting: Community-based telerehabilitation.

Participants: Stakeholders included group members (n = 8) who were low-income adults with chronic stroke (≥3 mo) and mild to moderate disability (National Institutes of Health Stroke Scale ≤ 16), group leaders (n = 4), and study staff (n = 4).

Intervention: Group-based intervention, ENGAGE, delivered using videoconferencing technology. ENGAGE blends social learning and guided discovery to facilitate community and social participation.

Outcomes and Measures: Semistructured interviews.

Results: Stakeholders included group members (ages 26–81 yr), group leaders (ages 32–71 yr), and study staff (ages 23–55 yr). Group members characterized ENGAGE as learning, doing, and connecting with others who shared their experience. Stakeholders identified social advantages and disadvantages to the videoconferencing environment. Attitudes toward technology, past technology experiences, the amount of time allotted for training, group size, physical environments, navigation of technology disruptions, and design of the intervention workbook were facilitators for some and barriers for others. Social support facilitated technology access and intervention engagement. Stakeholders recommended training structure and content.

Conclusions and Relevance: Tailored training protocols may support stakeholders who are participating in telerehabilitation interventions using new software or devices. Future studies that identify specific tailoring variables will advance the development of telerehabilitation training protocols.

What This Article Adds: These findings provide stakeholder-identified barriers and facilitators, in addition to stakeholder-informed recommendations, for technology training protocols that may support uptake of telerehabilitation in occupational therapy.

The study findings provide stakeholder-identified barriers and facilitators, as well as stakeholder-informed recommendations, for technology training protocols that may support uptake of telerehabilitation in occupational therapy.

Importance: Informal caregivers have valuable insights that occupational therapists can use to prevent and manage problems that may arise in people with spinal cord injury (SCI) because of a lack of physical activity and poor nutrition.

Objective: To assess caregiver-identified facilitators of weight management in people with SCI.

Design: Descriptive qualitative design using semistructured interviews and thematic analysis.

Setting: Regional SCI Care Model System and Veterans Health Administration.

Participants: Informal caregivers (n = 24) of people with SCI.

Outcomes and Measures: Facilitators of successful weight management in care recipients with SCI.

Results: Four themes were identified as weight management facilitators: healthy eating (subthemes: food content, self-control, self-management, and healthy preinjury lifestyle), exercise and therapy (subthemes: occupational and physical therapy, receiving assistance, and resources for exercise), accessibility, and leisure activity or activities of daily living, the latter described as a source of activity (because of required energy expenditure) to facilitate weight management for people with more severe injuries.

Conclusions and Relevance: These findings can inform the development of successful weight management plans by occupational therapists by incorporating feedback from informal caregivers. Because caregivers are involved in many of the facilitators identified, occupational therapists should communicate with the dyad about sourcing accessible places to increase physical activity and assessing in-person assistance and assistive technology needs to promote healthy eating and physical activity. Occupational therapists can use informal caregiver–identified facilitators of weight management to help prevent and manage problems for people with SCI secondary to limited activity and poor nutrition.

What This Article Adds: Occupational therapy practitioners provide therapeutic intervention to people with SCI; this includes attention to weight management from the time of initial injury throughout their lives. This article is novel in the presentation of informal caregivers’ perceptions about successful facilitators of weight management among people with SCI, which is important because caregivers are intimately involved in the daily activities of people with SCI and can be a liaison for occupational therapists and other health care providers about ways to facilitate healthy eating and physical activity.

This article is novel in the presentation of informal caregivers’ perceptions about successful facilitators of weight management among people with spinal cord injury (SCI), which is important because caregivers are intimately involved in the daily activities of people with SCI and can be a liaison for occupational therapists and other health care providers about ways to facilitate healthy eating and physical activity.

Importance: Fear and distress during immunization may lead to long-term preprocedural anxiety and nonadherence to immunization schedules. Pictorial stories provide a way of educating the parent and child about the procedure.

Objective: To determine the efficacy of pictorial stories in reducing pain perception among children and anxiety among mothers during immunization.

Design: Three-arm randomized controlled trial

Setting: Immunization clinic of a tertiary care hospital in South India.

Participants: Fifty children ages 5 to 6 yr, who reported to the hospital for measles, mumps, and rubella and typhoid conjugate virus vaccines. Inclusion criteria were that the child was accompanied by the mother and maternal knowledge of either Tamil or English. Exclusion criteria were child hospitalization in the past year or neonatal intensive care unit admission in the neonatal period.

Intervention: Pictorial story regarding immunization before the procedure that contained information related to immunization, coping strategies, and distraction techniques.

Outcomes and Measures: Pain perception was evaluated using the Sound, Eye, Motor Scale; the Observation Scale of Behavioral Distress; and the Wong-Baker FACES Pain Rating Scale (FACES). Maternal anxiety was measured using the General Anxiety–Visual Analog Scale.

Results: Of 50 children recruited, 17 were in the control group, 15 were in the placebo group, and 18 were in the intervention group. Children in the intervention group reported lower pain scores on the FACES (p = .04) compared with the placebo and control groups.

Conclusions and Relevance: A pictorial story is a simple and cost-effective intervention to reduce pain perception among children.

What This Article Adds: Pictorial stories may be a feasible, simple, and cost-effective intervention to reduce pain perception during immunization.

Using a pictorial story that includes information related to immunization, coping strategies, and distraction techniques may be a feasible, simple, and cost-effective intervention to reduce pain perception among children during immunization and provide a way of educating the parent and child about the procedure.

Importance: Approximately 7% to 30% of children contend with handwriting issues (HIs) in their school years. However, research studies to define and quantify HIs, as well as practical assessment tools, are lacking.

Objective: To confirm the validity and reliability of two screening scales for HIs: the Handwriting Legibility Scale (HLS) and the Concise Assessment Scale of Children’s Handwriting (BHK).

Design: Structural equation modeling (SEM) and confirmatory factor analysis (CFA) of five different models were used to examine the construct and discriminant validity of both scales. Furthermore, internal consistency and interrater agreement were evaluated. The association among scales, grades, and children’s self-evaluation was also explored.

Setting: Elementary schools and state counseling centers in the Czech Republic.

Participants: On a voluntary basis, 161 children from elementary schools and state counseling centers in the Czech Republic were enrolled. The variable of children with typical handwriting development versus HIs was missing for 11 children. Thus, for discriminant validity analysis, 150 data records from children were used.

Outcomes and Measures: The HLS and BHK were used to evaluate the handwriting quality of the transcription task. The Handwriting Proficiency Screening Questionnaires for Children was used for children’s self-evaluation.

Results: The study confirmed the validity and reliability of the shortened BHK and HLS. A strong relationship was found between the BHK and HLS, grades, and children’s self-evaluation.

Conclusions and Relevance: Both scales are recommended for occupational therapy practice worldwide. Further research should focus on developing standards and providing sensitivity studies.

What This Article Adds: Both the HLS and the BHK are recommended for occupational therapy practice. Practitioners should also take the child’s well-being into consideration in handwriting quality assessment.

This study confirms the validity and reliability of two screening scales for handwriting issues: the Handwriting Legibility Scale (HLS) and the Concise Assessment Scale of Children’s Handwriting (BHK), both of which are recommended for occupational therapy practice.

Importance: Mothers of children with disabilities experience health disparity. Interventions targeting maternal mental health need to be developed.

Objective: To determine the feasibility and preliminary effectiveness of the Healthy Mothers Healthy Families–Health Promoting Activities Coaching (HMHF–HPAC) intervention for mothers to improve participation in healthy activities and mental health and to evaluate outcome measures.

Design: Nonrandomized controlled pilot feasibility study with one group who received HMHF–HPAC and a control group.

Setting: Pediatric occupational therapy service; on site or telehealth.

Participants: Twenty-three mothers completed prequestionnaires; of those, 11 mothers participated in the intervention, and 5 did not (7 withdrew).

Intervention: Eleven pediatric occupational therapists were trained to deliver six 10-min sessions of HMHF–HPAC to mothers, integrated into their child’s therapy session or separately via telehealth.

Outcomes and Measures: Mixed-design analysis of variance explored changes in scores on the Depression Anxiety Stress Scale–21 Items and the Health Promoting Activities Scale.

Results: The intervention group reported, on average, significant reductions in depressive symptoms and stress symptoms and significant increases in participation in health-promoting activity. No significant main effect of time was found for these variables in the control group.

Conclusions and Relevance: The HMHF–HPAC program is a viable occupational therapy coaching intervention that can be embedded in existing services for families of children with disabilities. Future trials that evaluate the effectiveness of the HMHF–HPAC intervention for mothers of children with disabilities are warranted.

What This Article Adds: This article provides support for the feasibility of appropriate and sensitive outcome measures and program content and delivery to implement the novel HMHF–HPAC intervention in further research. Mothers of children with disabilities benefited from integrated HMHF–HPAC delivered by pediatric occupational therapists within the family’s existing services.

This article provides support for the feasibility and preliminary effectiveness of the novel Healthy Mothers Healthy Families–Health Promoting Activities Coaching (HMHF–HPAC) intervention for mothers of children with disabilities, which can be embedded in existing family services to improve participation in healthy activities and mental health and to evaluate outcome measures.

Importance: School engagement is the extent to which students commit to and participate in school activities, including internal thoughts, emotions, and observable behaviors. It is critical to children’s academic outcomes and mental health. Occupational therapy practitioners support children at school to maintain mental well-being and meet their school outcomes. However, how occupational therapy practitioners should measure school engagement among elementary school students remains unclear.

Objective: To identify and characterize how elementary school students’ school engagement is currently measured.

Data Sources: PsycINFO, Eric, CINAHL, and A+ Education databases. Two reviewers screened titles and abstracts, and one reviewer completed full-text screening and data extraction using Excel.

Study Selection: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guided this review. Studies published between 2015 and 2021 were included if full text was available, written in English, and used a measure designed for elementary school–age students. Studies were excluded if they used no school engagement measurement; used only infant, adolescent, or adult scales; were not available for review; and did not meet the inclusion criteria.

Findings: The review included 125 studies. A range of self-report, observational, teacher-report, and caregiver-report measures of school engagement were identified. Behavioral school engagement was most commonly measured. Included studies were primarily published in education and psychology fields, with none published in occupational therapy journals.

Conclusions and Relevance: A range of school engagement measurements can be found in the literature, but no consensus exists on a validated school engagement measurement for occupational therapy practice.

What This Article Adds: This review provides occupational therapy practitioners with a comprehensive understanding of (1) the importance of school engagement to mental health and (2) the range of behavioral, cognitive, and emotional engagement measures currently available for use with elementary school–age children, thereby enhancing the profession’s knowledge and scope of practice in school engagement.

This review provides occupational therapy practitioners with a comprehensive understanding of the importance of school engagement to mental health and the range of behavioral, cognitive, and emotional engagement measures currently available for use with elementary school–age children, thereby enhancing the profession’s knowledge and scope of practice in school engagement.

Importance: This systemic review synthesizes the existing literature to determine whether constraint-induced movement therapy (CIMT) is more effective than other approaches in improving upper extremity function in children diagnosed with hemiparesis associated with cerebral palsy (CP).

Objective: To advance the knowledge of the effectiveness of CIMT for occupational therapy practitioners by critiquing research conducted over the past 20 yr.

Data Sources: Databases used in the search were CINAHL, Health Source: Nursing/Academic Edition, PsycINFO, PubMed, Research Gate, and Google Scholar. Studies published from 2001 to 2021 were reviewed.

Study Selection and Data Collection: Articles were included if (1) the primary diagnosis was hemiparesis associated with CP; (2) participants were younger than age 21 yr; (3) constraint-induced therapy, CIMT, or other modified forms of CIMT were offered as an intervention; and (4) there was at least one group in the study.

Findings: Forty studies were included in the analysis. The results demonstrate that CIMT produces improved affected upper extremity function when compared with general rehabilitation. However, there were no differences in outcomes when bimanual approaches were compared with CIMT.

Conclusions and Relevance: The data support that CIMT is a beneficial and effective treatment when used to improve the upper extremity function of children with hemiparesis associated with CP. However, more Level 1b studies are needed to compare CIMT with bimanual therapy to determine which one is most effective and under which conditions.

What This Article Adds: This systematic review demonstrates that CIMT is an effective intervention when compared with other therapeutic approaches. This intervention can be used by occupational therapy practitioners who work with children diagnosed with hemiparesis associated with CP.

This systematic review demonstrates that constraint-induced movement therapy (CIMT) is an effective intervention when compared with other therapeutic approaches and can be used by occupational therapy practitioners who work alongside children diagnosed with hemiparesis associated with cerebral palsy (CP).

Importance: Feeding difficulties are common among preterm infants during neonatal intensive care unit (NICU) hospitalization. Although most preterm infants achieve full oral feeding by term-equivalent age, whether feeding difficulties persist despite the infant taking full volume and whether these difficulties may relate to other neurobehavioral challenges remain unclear.

Objective: To identify the prevalence of feeding problems among preterm infants and the relationships between infant feeding behaviors and neurobehavior at term-equivalent age.

Design: Cohort study.

Setting: Level 4 NICU with 85 beds.

Participants: Thirty-nine very preterm infants born ≤32 wk gestation (range = 22–32 wk). Exclusion criteria were congenital anomalies, >32 wk gestation at birth, and lack of feeding or neurobehavioral assessment at term-equivalent age.

Outcomes and Measures: Standardized feeding assessments using the Neonatal Eating Outcome Assessment and standardized neurobehavioral evaluation using the NICU Network Neurobehavioral Scale.

Results: Thirty-nine infants (21 female) were included in the final analysis. The mean Neonatal Eating Outcome Assessment score was 66.6 (SD = 13.3). At term-equivalent age, 10 infants (26%) demonstrated feeding challenges, 21 (54%) demonstrated questionable feeding issues, and 8 (21%) demonstrated normal feeding performance. Lower Neonatal Eating Outcome Assessment scores (poorer feeding performance) at term-equivalent age were associated with more suboptimal reflexes (p = .04) and hypotonia (p < .01).

Conclusions and Relevance: Feeding challenges and questionable feeding performance were prevalent among preterm infants at term-equivalent age and appeared in conjunction with suboptimal reflexes and hypotonia. Understanding this finding enables therapists to take a holistic approach to addressing feeding difficulties.

What This Article Adds: Elucidating the relationships between feeding performance and neurobehavior during the neonatal period allows for a better understanding of potential contributors to early feeding challenges and identifies targets for intervention.

Elucidating the relationships between feeding performance and neurobehavior during the neonatal period allows for a better understanding of potential contributors to early feeding challenges and enables occupational therapists to take a holistic approach in addressing feeding difficulties and identifying targets for intervention.

Importance: The activities that people engage in influence their well-being. Adults with low income have limited resources, which can affect their engagement in meaningful activities. Exploring the connection between meaningful engagement and well-being is an important step in providing occupational justice for this marginalized population.

Objective: To examine whether engagement in meaningful activities uniquely contributes to well-being for adults with low income after controlling for demographic variables.

Design: Cross-sectional exploratory study design.

Setting: Community agencies serving adults with low income, a local library, and a university union hall in northwest Ohio.

Participants: Adults with low income (N = 186).

Outcomes and Measures: Participants completed a demographic questionnaire, the Engagement in Meaningful Activities Survey (EMAS), and the World Health Organization–5 Wellbeing Index (WHO–5). We examined the influence of demographics and EMAS on the WHO–5.

Results: We identified a moderate correlation between the EMAS and WHO–5 (r = .52, p ≤ .05). Linear regression revealed an R ² = .27, F(7, 164) = 8.75, p < .001, with the EMAS and participant attributes as predictor variables. The R ² changed to .02 (p = .85) without the EMAS in the model.

Conclusions and Relevance: Findings support the need for and use of meaningful activities to support well-being and health for adults with low income.

What This Article Adds: Findings build on the evidence supporting the role of engagement in meaningful activities by drawing connections to a well-known and widely used measure of subjective psychological well-being and applying these connections to adults with low income. Occupational therapy practitioners can use measures such as the EMAS to strategically infuse aspects of meaning that promote engagement and foster well-being.

The study findings support the need for and use of meaningful activities to support well-being and health for adults with low income. Occupational therapy practitioners can use measures such as the Engagement in Meaningful Activities Survey (EMAS) to strategically infuse aspects of meaning that promote engagement and foster well-being.

Importance: Results of this study are helpful for the development of new faculty members who may have been trained as clinicians but not necessarily as academicians.

Objective: To determine occupational therapy faculty perceptions of their preparation for a teaching role, evaluate professional development activities in which educators currently engage, and identify teaching and learning topics most needed in future training activities.

Design: Quantitative, descriptive survey.

Setting: Educational institutions across the United States.

Participants: Occupational therapy and occupational therapy assistant faculty (N = 449).

Outcomes and Measures: A survey was created, pilot tested, and distributed. Questions were related to respondents’ institutional requirements and support for faculty development, developmental activities in which respondents participated, comfort levels with select teaching responsibilities, and topics of interest for additional development.

Results: Results show that training related to teaching and instructional design is not required but is highly encouraged at most educational institutions. Although most institutions do provide financial support for development opportunities outside of the institution, informal meetings are the predominant development activities both offered and used by faculty. Respondents cited learning how to develop test questions, designing course assignments, and learning about teaching methods and techniques as topics about which they would most like to gain more knowledge.

Conclusions and Relevance: These results inform a meaningful and necessary plan to train new occupational therapy faculty members as academicians and to ensure continuing development of experienced faculty for optimal performance and retention.

What This Article Adds: This report provides faculty and administrators with a starting point for the provision of faculty development content that has the potential not only to improve teaching skills but also to increase faculty self-confidence and retention.

The results of this study inform a meaningful and necessary plan to train new occupational therapy faculty members as academicians and to ensure continuing development of experienced faculty for optimal performance and retention.

There is an increasing need to diversify the profession of occupational therapy. To do this, we need to examine the pathway to becoming an occupational therapy practitioner in our education programs. Programs must go beyond a focus on diversity and place an equal emphasis on equity and inclusion. Underrepresented minority students report increased racial bias and a high occurrence of microaggressions in higher education programs, including occupational therapy. These microaggressions are often not addressed and can lead to increased stress, insecurity, and marginalization, as well as decreased retention rates. It is imperative that faculty examine the equity and inclusivity of their programs, and they should be supported in addressing their own implicit bias. Faculty, students, and staff should be equipped to address microaggressions as they occur. This article identifies examples of microaggressions and suggests strategies to address implicit bias and microaggressions in occupational therapy programs.

This article identifies examples of microaggressions and suggests strategies to address implicit bias and microaggressions in occupational therapy programs.