American Journal of Occupational Therapy

Importance: A contributing factor to the gap between research publication and clinical implementation is the lack of specificity used when reporting findings.

Objective: This scoping review used the Rehabilitation Treatment Specification System (RTSS) to determine which elements of specificity are most often present and omitted from research using Ayres Sensory Integration^® (ASI).

Data Sources: The following databases were searched: PubMed, CINAHL, PsycINFO, Cochrane Library, and ERIC.

Study Selection and Data Collection: Eligible studies used ASI in an outpatient setting with children who had sensory integration or processing difficulties. Studies selected were quantitative (Level 1, 2, 3, or 4), available in full text, peer reviewed, and published in English within the past 20 yr.

Findings: Of the 22 studies that met inclusion criteria, 100% included ingredients (actions of the therapist), 63% included mechanisms of action (reasoning behind these actions), 86% included targets, and 23% described client progression. We also found that 49% of all ingredients were listed in conjunction with a target, 15% were listed in conjunction with a mechanism of action, and 11% were listed in conjunction with both a target and a mechanism of action.

Conclusions and Relevance: Findings indicate that many studies list ingredients but often omit the mechanism of action. This omission makes replication of the intervention increasingly difficult and prevents a deeper understanding of the clinical reasoning process behind the intervention.

Plain-Language Summary: Gaps identified in this scoping review highlight inconsistencies in the reporting of treatment specificity that may affect the replication and translation of Ayres Sensory Integration^® (ASI) research into practice.

Gaps identified in this scoping review highlight inconsistencies in the reporting of treatment specificity that may affect the replication and translation of Ayres Sensory Integration^® (ASI) research into practice.

Importance: Clinical tests that identify fit and unfit drivers with 100% sensitivity and specificity would reduce uncertainty and improve efficiency of occupational therapists performing comprehensive driving evaluations (CDEs).

Objective: To examine whether serial trichotomization of clinical tests predicts pass–fail outcomes with 100% sensitivity and specificity in a sample of medically at-risk drivers and in drivers with and without cognitive impairment (CI) referred for a CDE.

Design: Retrospective data collection and analysis of scores on the Montreal Cognitive Assessment; Trail Making Test, Part A and Part B; and the Useful Field of View^® Subtests 1 to 3 and outcomes on the CDE (pass–fail or indeterminate requiring lessons and retesting). Receiver operating characteristic curves of clinical tests were performed to determine 100% sensitivity and specificity cut points in predicting CDE outcomes. Clinical tests were arranged in order from most to least predictive to identify pass–fail and indeterminate outcomes.

Setting: A driving assessment clinic.

Participants: Among 142 medically at-risk drivers (M age = 69.2 yr, SD = 14.1), 66 with CI, 46 passed and 39 failed the CDE; 57 were indeterminate.

Outcomes and Measures: On-road pass-fail outcomes.

Results: Together, the six clinical tests predicted 62 pass and 49 fail outcomes in the total sample; 21 pass and 34 fail outcomes in participants with CI; and 58 pass and 14 fail outcomes in participants without CI.

Conclusions and Relevance: Serial trichotomization of clinical tests increases the accuracy of making informed decisions and reduces the number of drivers undergoing unnecessary on-road assessments.

Plain-Language Summary: Clinical tests and their cut points that identify fit and unfit drivers vary substantially across settings and research studies. Serial trichotomization is one method that could help control for this variation by combining clinical test scores showing 100% sensitivity and specificity to identify pass (fit drivers) and fail outcomes (unfit drivers) and to reduce the number of drivers undergoing unnecessary on-road assessments.

This study found that the use of serial trichotomization in clinical tests of unfit drivers increases the accuracy of predicting pass and fail outcomes and reduces the number of drivers undergoing unnecessary on-road assessments.

Importance: Establishing empirical evidence on the psychometric properties of the Test of Visual–Motor Skills (3rd ed.; TVMS–3) is helpful for guiding its use as an assessment of visual–motor integration (VMI) skills in kindergarten children with developmental coordination disorder (DCD).

Objective: To investigate the test–retest reliability, criterion-related validity, and ecological validity of the TVMS–3 in Taiwanese kindergarten children with DCD.

Design: A nonexperimental, descriptive, correlational design.

Setting: A hospital in Central Taiwan.

Participants: Fifty-seven kindergarten children with DCD were recruited in the study.

Outcomes and Measures: Intraclass correlation coefficient, percentage of minimal detectable change, and paired t test (Wilcoxon signed rank test) were used to investigate the test–retest reliability of the TVMS–3. The correlations (Pearson’s r) between the TVMS–3 accuracy score and the scores of each of the four domains and the adaptive behavior composite score of the Vineland Adaptive Behavior Scales (3rd ed.; Vineland–3) were calculated, respectively, to examine criterion-related validity and ecological validity.

Results: The accuracy score of the TVMS–3 had excellent test–retest reliability and acceptable random measurement error. Moreover, it showed good criterion-related validity and sufficient ecological validity with the Vineland–3 in Taiwanese kindergarten children with DCD.

Conclusions and Relevance: The accuracy score of the TVMS–3 is applicable to Taiwanese kindergarten children with DCD in clinical and research settings.

Plain-Language Summary: The accuracy score of the Test of Visual–Motor Skills (3rd ed.; TVMS–3) is a useful assessment tool to detect deficits in visual–motor integration for Taiwanese kindergarten children with developmental coordination disorder. The TVMS–3 has excellent test–retest reliability, good criterion-related validity, and sufficient ecological validity.

The Test of Visual–Motor Skills is a useful assessment tool to detect deficits in visual–motor integration for Taiwanese kindergarten children with developmental coordination disorder.

Importance: Youths with autism spectrum disorder (ASD) have challenges with executive function (EF). However, there are few measures to objectively assess EF, such as time management and prioritization. The Weekly Calendar Planning Activity (WCPA) is a promising performance-based EF measure that has rarely been used with youths with ASD.

Objective: To characterize the performance of youths with ASD on the WCPA and the association of WCPA performance with caregiver-rated EF.

Design: Observational and summary data obtained during a baseline evaluation for a research study.

Setting: Middle school.

Participants: Thirty-nine adolescents with ASD and without an intellectual disability.

Method: Youth were administered the WCPA; caregivers completed EF ratings. Descriptive statistics characterized WCPA performance. Correlations between WCPA scores and age, IQ, and EF ratings were computed.

Results: The majority of youth performed poorly on the WCPA and lacked insight into their poor performance. Many struggled to enter appointments. Appointment accuracy was <30%. The most common errors were location errors. Appointment accuracy and planning time were moderately associated with IQ but not with caregiver-rated EF or age.

Conclusions and Relevance: Overall, the WCPA was cognitively demanding for youths with ASD without an intellectual disability. These results have implications for using evidence-based strategies to teach adolescents with ASD how to manage their time and plan and prioritize homework assignments, upcoming tests or quizzes, and extracurricular activities.

Plain-Language Summary: Youths with autism spectrum disorder have significant problems with executive function, particularly organization, prioritization, time management, and planning. There are few objective, performance-based measures of executive function, especially those that can be used with autistic youths. To our knowledge, this study is the first to use the Weekly Calendar Planning Activity (WCPA) with autistic adolescents who do not have an intellectual disability. The WCPA captured their deficits related to executive function and could be a useful tool for assessment and treatment planning.

This is the first study to use the Weekly Calendar Planning Activity with autistic adolescents who do not have an intellectual disability as a performance-based measure of executive function.

Importance: Persons living with and beyond cancer (PLWBC) are rarely referred to occupational therapy services despite their functional difficulties. An understanding of the barriers to and facilitators of occupational therapy referrals from the perspective of cancer health care professionals could help minimize referral gaps.

Objective: To explore cancer health care professionals’ perspectives on and knowledge of occupational therapy’s role in cancer care, identify the barriers, and explore solutions to optimize referrals.

Design: Multiexplanatory qualitative case study.

Setting: Community and hospital cancer clinics in Israel.

Participants: Six in-person focus groups of cancer care Israeli nurses and social workers, totaling 28 participants.

Results: Two main themes were identified: (1) barriers to occupational therapy referrals and (2) partial facilitators of occupational therapy referrals. The four barriers subthemes were (1) gaps in knowledge about symptoms’ effects on daily functioning, (2) gaps in knowledge regarding occupational therapy’s role in cancer care, (3) bureaucratic and organizational barriers, and (4) unavailability of occupational therapy services. The two facilitators subthemes were (1) collaborations and communication with occupational therapists and (2) awareness of occupational therapy services. Participants suggested practical solutions for improving occupational therapy referrals, interdisciplinary collaboration and communication, and integrating occupational therapy into cancer care.

Conclusions and Relevance: Barriers to referrals included gaps in participants’ knowledge that link side effects to functional difficulties indicating a need for referral to occupational therapy. Participants’ suggestions to bolster referrals can be implemented by occupational therapists to reduce patients’ unmet needs and bridge existing gaps in cancer care.

Plain-Language Summary: This research helped to identify barriers and facilitators regarding insufficient knowledge about occupational therapy’s role in cancer care and adds a better understanding of gaps in referrals to occupational therapy. In addition, cancer health care professionals who participated in the study suggested practical solutions for reducing barriers and maximizing support for referral. With these nuances, occupational therapy practitioners can work with medical cancer care units (i.e., acute care hospitals, medical cancer centers, and community health care clinics) to target the use of strategies that work for their units to ensure that persons living with and beyond cancer receive needed occupational therapy services.

This research identifies barriers and facilitators regarding insufficient knowledge about occupational therapy’s role in cancer care and adds a better understanding of gaps in referrals to occupational therapy.

Importance: Occupational therapists often address financial occupations of clients with acquired functional impairments who experience challenges with financial capability (FC).

Objective: To explore the intervention literature aimed at improving FC in five diagnostic adult populations.

Data Sources: MEDLINE, CINAHL, PsycInfo, EconLit, and EMBASE; researchers also completed backward and forward citation searching and contacted expert authors.

Study Selection and Data Collection: Two independent reviewers completed article screening, selection, and extraction using a scoping review approach; a priori inclusion criteria were peer-reviewed articles, written in English, involving adults with one of five diagnostic conditions, describing any intervention to improve FC.

Findings: Twenty-four articles met the inclusion criteria. Most articles were aimed at substance use or mental health populations (n = 20); fewer focused on brain injury (n = 2), multiple sclerosis (n = 1), or mixed-diagnosis (n = 1) populations. Only 4 were randomized controlled trials (RCTs). Interventions were heterogeneous and complex, including components of skills training (n = 21), individualized budgeting (n = 18), representative payeeship (n = 11), education (n = 10), structured goal setting (n = 7), savings building (n = 5), metacognitive strategies (n = 2), and assistive technology (n = 1).

Conclusions and Relevance: Despite growth in the area, the literature regarding FC intervention is limited, with few RCTs and many populations unrepresented. The literature for a systematic review of FC intervention efficacy for these populations is insufficient, particularly because included studies used varied components, limiting comparison. Further research is imperative to guide evidence-based practice.

Plain-Language Summary: This study is an overview of literature about interventions to address the financial occupations of clients with acquired functional impairments. The findings give occupational therapy researchers and clinicians the information they need to begin analyzing, using, and building the evidence to support the use of interventions to improve clients’ financial capability and well-being.

This study provides an overview of literature regarding interventions to improve the financial capability of clients with acquired functional impairments.

Importance: An association between sensory processing difficulties and behavioral problems among children has been reported in previous studies. Sleep problems among children can lead to both externalizing and internalizing behavioral problems. However, the relationships between sensory processing and sleep among children are not well understood.

Objective: To develop a structural causal model (SCM) predicated on the hypothesis that sensory processing difficulties and sleep problems are closely related among preschoolers and may contribute to behavioral issues.

Design: Cross-sectional study.

Participants: A total of 168 children ages 3–5 yr who were enrolled in a preschool or an accredited kindergarten (four facilities in total) in a Japanese prefecture participated in the analysis.

Outcomes and Measures: After gaining the cooperation of educators, we distributed the following items to the children’s parents: an informed consent form, the Short Sensory Profile–Japanese version (SSP–J), the Japanese Sleep Questionnaire for Preschoolers (JSQ–P), and the Child Behavior Checklist for Ages 1.5–5. Through factor analysis of the SSP–J and the JSQ–P, we identified common factors. We developed an SCM using structural equation modeling.

Results: Four factors were identified by factor analysis: attention deficit, sensory sensitivity, sleep problems, and restless legs syndrome symptoms. The final structural equation modeling analysis had an acceptable goodness of fit (goodness-of-fit index = .862; root-mean-square error of approximation = .087).

Conclusions and Relevance: The model suggests that sensory sensitivity and sleep difficulties may contribute to behavioral issues among preschoolers.

Plain-Language Summary: The results of this study suggest that relationships exist between behavioral problems, sensory processing, and sleep among preschoolers. The authors developed a model that identified four common factors that contribute to behavioral issues among preschoolers: attention deficit, sensory sensitivity, sleep problems, and restless legs syndrome symptoms. Children’s behavioral problems are an important consideration for occupational therapy practitioners working with preschoolers. Sensory processing and sleep must be accurately evaluated to address preschoolers’ behavioral issues.

Children’s behavioral problems are an important consideration for occupational therapy practitioners working with preschoolers. The results of this study suggest that relationships exist between behavioral problems, sensory processing, and sleep among preschoolers.

Importance: Understanding burnout among practitioners in skilled nursing facilities (SNFs) and assisted living facilities (ALFs) while considering contextual factors may lead to practices that enhance therapist and patient satisfaction as well as quality of care.

Objective: To examine productivity standards and burnout in the context of setting and role, as reported by therapy practitioners in geriatric settings, and to explore relationships between productivity standards and perceived ethical pressures.

Design: Cross-sectional online survey with descriptive data.

Participants: Practitioners (N = 366) included occupational therapists, physical therapists, speech-language pathologists, and occupational and physical therapy assistants working in SNFs and ALFs in the United States. A survey integrating the Maslach Burnout Inventory: Human Services Survey for Medical Personnel (MBI–HSS) and questions addressing demographics and contextual factors was distributed via social media.

Results: Of 366 practitioners, 20.5% were burned out, exhibiting extreme scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) on the MBI–HSS. Significant relationships between productivity requirements and EE, DP, and PA, after accounting for covariates, were evident. Significant relationships between productivity standards and five of the six ethically questionable behaviors existed. Role affected productivity requirements, specifically between therapists and assistants, whereas setting did not.

Conclusions and Relevance: Productivity standards and related pressures are associated with concerning aspects of burnout among practitioners working in geriatric settings. Advocating for change in defining productivity and incorporating positive support in the work environment may assist in reducing burnout and turnover rates and improve patient satisfaction and care.

Plain-Language Summary: This research highlights the prevalence of burnout and perceived pressures related to productivity requirements among occupational therapy practitioners working in skilled nursing and assisted living facilities.

This research highlights the prevalence of burnout and perceived pressures related to productivity requirements among occupational therapy practitioners working in geriatric settings.

Importance: Driving and community mobility (DCM) is key to supporting independence in teens and young adults (TYA) with autism spectrum disorder (ASD).

Objective: To determine whether an intervention focused on DCM can effectively improve DCM knowledge and skills in TYA.

Design: A pretest–posttest design using the same intervention and outcome measures.

Setting: University research setting.

Participants: Thirty-eight participants with ASD completed the program (M age = 17.76 yr, SD = 3.58). Twenty-six (68%) were male, and 12 (32%) were female.

Intervention: A 5-day intensive intervention using group and individualized strategies, including driving simulation, focused on improving performance skills needed for DCM.

Outcome and Measures: Total and category scores of the Performance Analysis of Driving Ability (P-Drive) were analyzed using a repeated-measures analysis of variance measuring time (pretest vs. posttest), gender, and year of intervention. Paired t tests were used to determine the outcomes of the Canadian Occupational Performance Measure (COPM), anxiety measure and perception survey.

Results: Results indicated a significant main effect for time (p < .001) and year (p < .036), but not gender (p < .26), with no significant interaction effects, supporting the fidelity of the intervention. The COPM showed significant changes (p ≤ .001) in both performance and satisfaction, as well as a reduction in anxiety (p = .008).

Conclusions and Relevance: Outcomes suggest that the intervention successfully improved DCM knowledge and skills for TYA. This adds new evidence that an occupational therapy intervention specific to TYA with ASD is effective in developing independence in DCM.

Plain-Language Summary: Driving is the primary mode of community mobility in North America and other Western countries. Adults with autism spectrum disorder (ASD) who have a means of community mobility have a chance of employment that is 5 times greater than that for those who do not. Driving and community mobility are key to supporting independence among teens and young adults with ASD. However, teens and young adults with ASD have significantly lower rates of getting a driver’s license. The results of this study show that occupational therapy practitioners can play a critical role in addressing driving and community mobility. Occupational therapy interventions that are specifically designed for and unique to each teen and young adult with ASD can effectively improve driving and community mobility skills and increase independence.

The results of this study show that occupational therapy practitioners can play a critical role in addressing driving and community mobility among teens and young adults with autism spectrum disorder to support independence.

Importance: Spiritual well-being is an important aspect of health-related quality of life for persons with chronic illnesses such as multiple sclerosis (MS), yet research on interventions remains limited.

Objective: To assess the feasibility of an occupational therapy intervention addressing the spiritual well-being of people with MS.

Design: Mixed-methods program evaluation using theoretical thematic analysis of qualitative data.

Setting: Community center serving people with MS in a midwestern U.S. city.

Participants: A total of 42 participants attended at least one session; 22 participants provided qualitative data. Ten met the inclusion criteria for quantitative analysis, including completion of pretest and posttest measures and attendance of at least half of the sessions.

Intervention: Making Meaning, a group intervention based on the Model of Occupational Wholeness, was conducted over eight weekly 45-min sessions. The focus was on exploring and integrating spiritual practices into daily life.

Outcomes and Measures: Participants completed the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being 12-Item Scale (FACIT–Sp–12) to measure spiritual well-being and answered open-ended questions. Attendance was recorded and the facilitator and observers provided qualitative observations.

Results: Pretest–posttest comparisons of FACIT–Sp–12 scores indicated a moderate improvement in spiritual well-being (d = 0.41). Attendance and qualitative data supported the intervention’s feasibility and suggested areas for refinement.

Conclusions and Relevance: Making Meaning is a feasible intervention, showing promise for promoting spiritual well-being for people with MS. Further research is warranted.

Plain-Language Summary: This study introduces a practical and acceptable occupational therapy group intervention, Making Meaning, which shows promising potential for improving the spiritual well-being of people with multiple sclerosis.

Making Meaning is a group intervention that shows promise for improving spiritual well-being for people with multiple sclerosis.

Importance: Evidence for the positive effects of occupation-based interventions on occupational performance is increasing; however, little is known about the impacts of occupation-based interventions on older adults living in long-term care.

Objective: To consolidate the evidence on the effectiveness of occupation-based interventions for improving occupational performance among older adults living in long-term care.

Data Sources: MEDLINE, CINAHL, PsycINFO, SCOPUS, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from journal–database inception to February 2023.

Study Selection and Data Collection: This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles were peer-reviewed studies published in English that evaluated occupation-based interventions for older adults living in long-term care and used validated tools to measure occupational performance.

Findings: Seventeen articles, with 2,974 participants, were identified. The reviewed studies included 6 Level 1b randomized controlled trials, 5 Level 2b studies of various study designs, and 5 Level 3b studies with quasi-experimental designs. Across studies, heterogeneous measures were used to assess occupational performance. All studies implemented client-centered, occupation-based interventions designed and/or delivered by occupational therapists. Interventions were tailored to residents’ goals, interests, or abilities to improve occupational performance and participation, and inconsistent effects were reported.

Conclusions and Relevance: Moderate evidence supports the use of occupation-based interventions tailored to individual residents and incorporation of physical activities for improving the occupational performance of older adults living in long-term care. Currently, evidence for care partner involvement and multilevel occupation-based interventions is limited.

Plain-Language Summary: This study adds to the evidence base indicating that occupation-based interventions have the potential to promote the occupational performance of older adults living in long-term care. High-quality randomized controlled trials with longer term follow-up and assessment of clinically meaningful outcomes are critical for developing the evidence base in this practice setting.

This systematic review adds to the evidence base indicating that occupation-based interventions have the potential to promote the occupational performance of older adults living in long-term care.

Importance: Clarifying the relationship between kindergarteners’ characteristics and their future handwriting performance is beneficial for the early detection of children at risk of handwriting difficulties.

Objective: To determine which visual–perceptual and motor skills and behavioral traits significantly predict kindergartners’ Chinese handwriting legibility and speed in the first grade.

Design: One-year longitudinal, observational design.

Setting: Kindergarten and elementary schools.

Participants: One hundred six kindergarten children (53 boys and 53 girls; ages 5 or 6 yr) were recruited.

Outcomes and Measures: The participants completed two subtests of the Bruininks–Oseretsky Test of Motor Proficiency–Second Edition, Test of Visual Perceptual Skills–Third Edition, Beery–Buktenica Developmental Test of Visual–Motor Integration (Beery™ VMI), and the Attention-Deficit/Hyperactivity Disorder Test–Chinese Version in kindergarten. Their handwriting legibility (character accuracy and construction) and speed were assessed by investigator-developed Chinese handwriting tests in the first grade.

Results: Multivariate regression analyses indicated the independent predictive power of spatial relationships (p = .042) and inattention (p = .004) for character accuracy. Visual–motor integration (VMI; p = .008) and inattention (p = .002) were the key predictors of character construction. Manual dexterity (p = .001) was the only significant predictor of writing speed.

Conclusions and Relevance: Kindergarteners who perform poorly in spatial relationships, VMI, manual dexterity, and attention are likely to have less legible Chinese handwriting and slow writing speed in first grade.

Plain-Language Summary: Children’s visual–perceptual and motor skills and behavioral traits in kindergarten can predict their Chinese handwriting legibility and speed in first grade. This study found that kindergarteners who performed poorly in spatial relationships, VMI, manual dexterity, and attention were likely to have less legible Chinese handwriting and slow writing speed in the first grade.

This study found that kindergarteners who performed poorly in spatial relationships, visual–motor Integration, manual dexterity, and attention were likely to have less legible Chinese handwriting and slow writing speed in the first grade.

Importance: The Supporting and Enhancing NICU Sensory Experiences (SENSE) program is an evidence-based intervention that promotes daily, positive sensory exposures for infants in the neonatal intensive care unit (NICU). Understanding program implementation across sites may aid in optimizing strategies for uptake of the program and subsequently improve outcomes for infants and families.

Objective: To investigate health care professionals’ perceptions of implementing the SENSE program.

Design: The SENSE Program Implementation Survey was developed using Proctor et al.’s model and the BARRIERS scale to probe organizational practices across sites worldwide.

Setting: Survey distributed to 211 hospitals with a SENSE program license obtained before March 2020.

Participants: One hundred fourteen NICU personnel (response rate = 54%).

Outcomes and Measures: The survey sought to understand barriers and facilitators, adaptations during implementation, and associated costs.

Results: Of the 53% (n = 57 of 107) of respondents who had implemented the SENSE program, many (n = 14; 31%) experienced quick timing (<1 mo) to use, including spread to nearly all infants in their NICU within 6 mo (n = 18; 35%). Most reported the program was used to educate families ≤3 days of birth (n = 20/59; 34%). Most of the sensory interventions in the program were performed by parents (n = 38; 67%) and therapists (n = 44; 77%). Barriers and facilitators at the organizational and individual levels were identified. No additional staff were hired to implement the program.

Conclusions and Relevance: Given perceived successes and challenges, strategic enhancement of implementation can inform future administrations of the SENSE program.

Plain-Language Summary: This study provides occupational therapists who are interested in implementing the SENSE program (Supporting and Enhancing NICU Sensory Experiences) with an understanding of common barriers, facilitators, costs, and adaptations, which can be used to advocate for program implementation in NICUs to improve outcomes for preterm infants worldwide.

This study provides occupational therapists who are interested in implementing the SENSE program (Supporting and Enhancing NICU Sensory Experiences) with an understanding of common barriers, facilitators, costs, and adaptations.

Importance: Implementing evidence-based practice (EBP) is essential for ensuring optimal quality care and obtaining positive outcome in treatment. Occupational therapists generally hold positive attitudes toward EBP; however, EBP is not always fully implemented.

Objective: To explore the mediating role of self-efficacy on the relationship between implementing EBP and burnout among occupational therapists.

Design: A cross sectional study.

Setting: Data were collected through social media and WhatsApp groups using an online survey accessible through Qualtrics, a secured web-based data collection system; responses were anonymous.

Participants: The final sample consisted of 261 female Israeli occupational therapists (ages 24–65 yr, with 1–40 yr of clinical experience).

Outcomes and Measures: The following questionnaires assessed EBP implementation, burnout, and self-efficacy, respectively: the EBP Implementation Scale, the Maslach Burnout Inventory, and the Occupational Therapy Self-Efficacy Questionnaire. Demographic data were also collected.

Results: EBP implementation was low (0-43 points out of a maximum 72 points), moderate levels of burnout and high levels of self-efficacy were reported. Significant associations with medium effect sizes were found between EBP implementation and burnout: the higher the levels of EBP implementation, the lower the levels of burnout frequency and intensity. Moreover, self-efficacy mediated these relationships. EBP implementation was related to elevated self-efficacy, which, in turn, was associated with lower burnout.

Conclusions and Relevance: EBP implementation may serve as an important tool to limit burnout among occupational therapists by fostering their trust in their ability to handle clinical challenges. Further research is needed.

Plain-Language Summary: This study explored implementing evidence-based practice (EBP) and its relationships to burnout and work-related self-efficacy among occupational therapists. The study found that self-efficacy mediated the relationships between implementing EBP and burnout. Implementing EBP was associated with higher self-efficacy, which, in turn, was associated with lower burnout among occupational therapists.

This study explored implementing evidence-based practice (EBP) and its relationships to burnout and work-related self-efficacy among occupational therapists.

Importance: Sensory processing difficulties are commonly seen in people with mental disorders. However, no questionnaires specific to Turkish culture are available for people with mental disorders.

Objective: To examine the cultural adaptation, reliability, and validity of the Turkish Sensory Responsiveness Questionnaire (SRQ).

Design: Causal comparative groups design.

Setting: Homes, clinics, hospitals, and therapy practices in Turkey.

Participants: A total of 913 participants, of whom 529 were participants ages 18–60 yr with mental disorders.

Outcomes and Measures: The cross-cultural adaptation and translation procedures were conducted following Beaton’s guidelines. Internal consistency was examined with Cronbach’s α. Criterion-related validity of the SRQ was determined with the Adolescent/Adult Sensory Profile using construct validity and was examined by confirmatory factor analysis (CFA) using IBM SPSS Statistics (Version 23) and AMOS (Version 24.0).

Results: In CFA, model fit indices showed an acceptable fit. Test–retest reliability was excellent for the hedonic and avoidance subfactor scores and for the total score (intraclass correlation coefficients = .973, .988, and .974, respectively). Internal consistency was high for the hedonic subfactor (.812) and the avoidance subfactor (.815). Participants with bipolar disorder had the highest scores on the hedonic subfactor, whereas those with schizophrenia had the highest scores on the avoidance subfactor.

Conclusions and Relevance: The 36-item SRQ is reliable and valid for analyzing the sensory processing abilities of adults in the Turkish population.

Plain-Language Summary: People with mental disorders commonly have difficulties with sensory processing. No sensory responsiveness questionnaire specific to the Turkish population or culture is available for people with mental disorders. This study shows that the current form of the Turkish Sensory Responsiveness Questionnaire can contribute to understanding the sensory processing abilities of Turkish people with and without mental disorders.

This study shows that the current form of the Turkish Sensory Responsiveness Questionnaire can contribute to understanding the sensory processing abilities of Turkish people with and without mental disorders.

Importance: Built environment structures affect a population’s occupational participation and health outcomes.

Objective: To examine how occupational opportunities available within walking distance are related to a community’s overall health.

Design: Secondary data analysis.

Setting: Community.

Participants: Community-dwelling adults.

Outcomes and Measures: Data from the AARP Livability Index and Walk Score^® for 78 zip codes were used for path analysis and multiple regression analysis to investigate the relationship between various community factors and the health of the community.

Results: Path analysis for 78 zip codes revealed that the primary determinants of health score were destination diversity and social walk score. Multiple regression analysis revealed that destination diversity (β < .001) and exercise opportunity (β < .001) were significant factors for health score. Multiple regression analysis revealed that destination diversity (β < .001) was a significant factor for social score.

Conclusions and Relevance: The results suggest that increased diversity of destinations in a community and opportunities available for social participation within walking distance are associated with better health of residents in the community.

Plain-Language Summary: This study highlights how the built environment and opportunities for social participation are associated with a community’s overall health. This study found that participation in a variety of group activities contributes to community members’ well-being. Understanding how the built environment is related to health outcomes may better equip occupational therapy practitioners to improve the health of an individual, group, or population.

This study highlights how the built environment and opportunities for social participation are associated with a community’s overall health.

Importance: No single cognitive screen adequately captures all cognitive domains that are important for inpatient occupational therapy treatment planning.

Objective: To quantify the content validity of a novel 22-item cognitive screen, the Gaylord Occupational Therapy Cognitive (GOT–Cog) screen, developed to better inform inpatient occupational therapy treatment planning.

Design: Delphi-style expert panel review.

Setting: Long-term acute care hospital.

Participants: The first panel was attended by four occupational therapists, two speech-language pathologists, one physician assistant, and two neuropsychologists; the second, by four occupational therapists, one speech-language pathologist, and one physician assistant.

Intervention: Each Delphi panel discussed the relevance, essentiality, and clarity of each item. After each discussion, panelists completed a content validity survey to summarize their evaluation of each item.

Outcomes and Measures: On the basis of panelists’ survey responses, item- and scale-level relevance, essentiality, and clarity were quantified by calculating the respective content validity index (CVI), content validity ratio (CVR), and content clarity index (CCI). Universal agreement (UA) and κ statistics were also calculated, as appropriate.

Results: Upon presenting the initial 23-item instrument covering 10 cognitive domains to the first Delphi panel, several questions were added, removed, or rewritten, resulting in a 22-item instrument representing nine domains. After the second panel, several questions were again rewritten, and the domains reorganized. All scale-level metrics improved, including CVI (from 0.87 to 1.0), UA (0.52 to 1.0), CVR (0.43 to 0.94), and CCI (2.26 to 2.92).

Conclusions and Relevance: GOT–Cog displays overall excellent content validity and can proceed to construct validity testing.

Plain-Language Summary: By reporting on the content validity of the Gaylord Occupational Therapy Cognitive screen, this brief report begins the necessary process of evaluating the measure’s overall validity and reliability.

By reporting on the content validity of the Gaylord Occupational Therapy Cognitive screen, this brief report begins the necessary process of evaluating the measure’s overall validity and reliability.

Although occupational therapy has its roots in mental health practice, the profession has not been able to adequately and consistently address mental health issues that face society today. As we continue to experience both the protracted coronavirus disease 2019 pandemic and political and social unrest, occupational therapy professionals must take action at individual, state, and national levels to assist in mitigating the current mental health tsunami and improving a fractured mental health care system. In this column, we define and explore issues facing the mental health care system and the different roles and perspectives that are relevant to occupational therapy professionals. Recommendations for the future are provided: actions that can be facilitated at the individual level, in practice, education, and research; at the state level, through state organizations and strategic partnerships; and at the national level, through the American Occupational Therapy Association and other means of advocacy. We want to honor Mary Reilly’s vision that occupational therapy become one of the greatest ideas of our time.

In this column, the authors define and explore issues facing the U.S. mental health care system and the different roles and perspectives that are relevant to occupational therapy professionals.

Accreditation standards covering occupation have evolved across recent versions of the Accreditation Council for Occupational Therapy Education’s (ACOTE^®’s) academic B content standards. Because occupational therapy and occupational therapy assistant academic programs are required to provide evidence of compliance with each B content standard, the level of students’ learning of occupation warrants attention. The revised Bloom’s taxonomy offers a useful framework for examining hierarchical learning action verbs that underpin the degree of complexity of students’ learning of occupation within the ACOTE standards. In this column, we provide an analysis of action verbs across ACOTE standards from 2006 to the most recent, 2018 version. The findings reveal a reduction in accreditation requirement trends covering occupation in both lower and higher order cognitive skill levels as described in the revised Bloom’s taxonomy. We advocate for increased curricular content centered on the foundations of occupation so that students and future practitioners can increasingly apply, analyze, evaluate, and creatively use occupation in the classroom and in practice.

The authors advocate for increased curricular content centered on the foundations of occupation so that students and future practitioners can increasingly apply, analyze, evaluate, and creatively use occupation in the classroom and in practice.

In this State of the Science column, we examine evidence that aligns common applications of diversity, equity, and inclusion (DEI) and occupational therapy research and suggest areas of focus to advance a culturally affirming and antiracist science of occupation. More specifically, we describe why DEI is important to the study of occupation, identify DEI gaps in the occupational therapy knowledge base, suggest DEI priorities for occupational therapy research and their implications for practice, and recommend practical strategies for occupational therapy scholars to apply in more immediate efforts to address DEI in their research endeavors.

This State of the Science column examines evidence that aligns common applications of diversity, equity, and inclusion and occupational therapy research and suggests areas of focus to advance a culturally affirming and antiracist science of occupation.

Importance: There are currently 55 million adults living with declining functional cognition—altered perception, thoughts, mood, or behavior—as the result of Alzheimer’s disease (AD) and related neurocognitive disorders (NCDs). These changes affect functional performance and meaningful engagement in occupations. Given the growth in demand for services, occupational therapy practitioners benefit from consolidated evidence of effective interventions to support adults living with AD and related NCDs and their care partners.

Objective: These Practice Guidelines outline effective occupational therapy interventions for adults living with AD and related NCDs and interventions to support their care partners.

Method: We synthesized the clinical recommendations from a review of recent systematic reviews.

Results: Twelve systematic reviews published between 2018 and 2021 served as the foundation for the practice recommendations.

Conclusion and Recommendations: Reminiscence, exercise, nonpharmacological behavioral interventions, cognitive therapy, sensory interventions, and care partner education and training were found to be most effective to support adults living with AD and related NCDs.

Plain-Language Summary: These Practice Guidelines provide strong and moderate evidence for occupational therapy practitioners to support adults living with Alzheimer’s disease (AD) and related neurocognitive disorders (NCDs) and their care partners. They provide specific guidance for addressing the decline in cognition, behavioral and psychological symptoms of dementia, and pain experience of adults living with AD and related NCDs. The guidelines also describe interventions to support care partners. With support from the evidence, occupational therapy practitioners are better equipped to address the unique needs of adults living with AD and related NCDs and their care partners.

These Practice Guidelines provide strong and moderate evidence for occupational therapy practitioners to support adults living with Alzheimer’s disease and related neurocognitive disorders and their care partners.