American Journal of Occupational Therapy

Thank you for the opportunity to respond to Whiting et al.’s (2025) Letter to the Editor, “Occupational Therapy Using Ayres Sensory Integration^® in School-Based Practice: A Call to Action.” We appreciate the opportunity to dispel misconceptions about Ayres Sensory Integration (ASI) and describe its use as an evidence-based approach.

Importance: Although gamification is recognized for enhancing motivation and learning outcomes, there is a need for specific evidence on how innovative methods, such as educational escape rooms, affect learning experiences and teamwork.

Objective: This study examined the effectiveness of using the educational escape room as an innovative approach for occupational therapy (OT) and occupational therapy assistant (OTA) students.

Design: One-group, preexperimental, pre- and poststudy.

Setting: A simulation laboratory at a university.

Participants: Seventy-six OT and 38 OTA students enrolled in clinical skills classes were randomly assigned to teams of OT and OTA students.

Intervention: An escape room incorporating associated topics covered in the clinical skills course. Students worked collaboratively and applied their combined knowledge and critical thinking skills to solve 10 puzzles to escape in 1 hr.

Outcomes and Measures: The Readiness for Interprofessional Learning Scale, Self-Assessment Scale for Active Learning and Critical Thinking, and a researcher-developed knowledge assessment were administered 2 wk before and immediately after the escape room experience to evaluate the students’ intraprofessional collaboration, activity learning, critical thinking skills, and knowledge levels.

Results: Students’ readiness for teamwork, activity learning, and critical thinking skills increased after participating in the escape room experience. Students’ knowledge levels also improved, with a moderate effect size. These results suggest the possible benefits of educational escape rooms.

Conclusions and Relevance: Escape rooms are an increasingly popular, innovative teaching modality in health care education. This study validated that escape rooms promote students’ learning outcomes and intraprofessional teamwork.

Plain-Language Summary: This study assessed the effectiveness of using an escape room as a teaching tool in a clinical skills class for occupational therapy (OT) and occupational therapy assistant (OTA) students. The findings revealed significant improvements in the students’ teamwork, active learning, critical thinking skills, and knowledge levels after the escape room experience. These results suggest that incorporating escape rooms into OT education can enhance learning outcomes and should be further explored in future studies with more rigorous experimental designs. This innovative approach benefits students’ academic development and can affect OT practice. Fostering collaboration and critical thinking better prepares students to provide comprehensive and effective care to their future clients. This study contributes to the growing body of research that supports active learning pedagogies in OT education, highlighting the importance of engaging and experiential learning methods in preparing students for real-world practice.

This study assessed the effectiveness of using an escape room as a teaching tool in a clinical skills class for occupational therapy and occupational therapy assistant students.

Importance: Limited availability of Spanish-translated clinical assessment tools perpetuates disparities in health care access for Spanish-speaking Latinos in the United States. The Measure Yourself Medical Outcome Profile^® (MYMOP) is a patient-reported outcome measure that has demonstrated utility for use with older Latinos, but a licensed Spanish-language version is not available.

Objective: To develop, validate, and assess the readability of a culturally relevant translation of the MYMOP for U.S. Spanish-speaking Latinos.

Design: A multiphase, systematic translation process involving cognitive debriefing with target respondents and validity and readability analysis.

Setting: Data collected in-person or online within the general Latino community.

Participants: Forty Spanish-speaking volunteers age 45 years or older identifying as Latino/Hispanic, living in the United States, and reporting one or more chronic health conditions were recruited.

Outcomes and Measures: The Latin-American Spanish translation of the MYMOP (MYMOP–LAS), a person-centered tool that evaluates overall well-being, symptom severity, and symptom impact on daily activities, was cross-sectionally compared with the EuroQol Five-Dimension Five-Level (EQ-5D-5L) health-related quality of life measure.

Results: Participants found the MYMOP–LAS generally understandable but recommended revisions to improve clarity and alignment with colloquial Spanish. The MYMOP–LAS baseline profile score and three of four subscales correlated significantly with the EQ-5D-5L utility index score (r = −.473 to −.519, ps ≤ .013). The MYMOP–LAS met expectations for readability (approximately fifth-grade reading level).

Conclusions and Relevance: Preliminary evidence supports the validity and readability of the MYMOP–LAS for use with the U.S. Latino Spanish-speaking community. Additional research on the MYMOP–LAS’s psychometric properties is warranted.

Plain-Language Summary: In the United States, there is a shortage of clinical assessment tools for Spanish-speaking Latinos. This study aimed to develop a culturally relevant and readable Latin-American Spanish translation of the Measure Yourself Medical Outcome Profile^® 2 (MYMOP–LAS). Forty Latinos age 45 yr and older living in the United States completed and critiqued a draft of the MYMOP–LAS. Participants understood the questionnaire but suggested changes to improve its clarity and alignment with more casual Spanish language. MYMOP–LAS scores aligned with another quality of life measure, corroborating MYMOP-LAS’s validity. The tool was readable at about a fifth-grade reading level. This study provides support for using the MYMOP–LAS with Spanish-speaking Latino communities in the United States.

Positionality Statement: The authors use Latino or Hispanic as a gender-inclusive term to describe participants but recognize the complexities of labeling ethnic and cultural identity. Three authors identify as Spanish–English bilingual Latino and two as English monolingual, non-Hispanic White. All authors have advanced training; most hold graduate or postgraduate degrees.

This study provides support for using the Measure Yourself Medical Outcome Profile^® (MYMOP–LAS) with Spanish-speaking Latino communities in the United States.

Importance: Determining cognitive fitness to drive is challenging. A previous study used serial trichotomization with five cognitive tests to determine whether drivers should continue driving, undergo further evaluation, or stop driving.

Objective: To examine agreement between serial trichotomization and fitness-to-drive determinations made by occupational therapists.

Design: Drivers referred for cognitive screens completed all tests used in the previous study. Occupational therapists provided fitness-to-drive recommendations (safe, indeterminate, or unsafe) using all clinical information available. We examined the agreement between the tests’ results (using cut points from the previous study) and occupational therapists’ recommendations.

Setting: Outpatient neurology program at a chronic care and rehabilitation hospital.

Participants: 279 clients (M age  = 66.35 yr; SD = 13.25).

Outcomes and Measures: Tests included the Trail Making Tests A and B, the Clock Drawing Test (CDT), the Montreal Cognitive Assessment, and the Motor-Free Visual Perception Test, using a road test as the gold standard. The previous study used dual cut points with 100% sensitivity and specificity to reduce false positives and false negatives.

Results: Weighted κs ranged from .03 (95% confidence interval [CI] [−.01, .08]) for the CDT to .54 (95% CI [.46, .62]) for the Trail Making Test, Part B. Although the agreement between serial trichotomization and the final recommendations was moderate (κ = .59; 95% CI [.50, .67]), serial trichotomization appeared useful for identifying unsafe drivers.

Conclusions and Relevance: These results remind us of the variability inherent in stand-alone cognitive tests, even within a serial trichotomization framework, and the importance of clinical judgement and road tests in decision making about driving.

Plain-Language Summary: It can be challenging for occupational therapists to accurately determine a client’s cognitive fitness to drive. Many occupational therapists lack the time, have limited training, or do not have access to comprehensive driving evaluation tools. A serial testing approach can support occupational therapists in assessing a client’s cognitive fitness to drive. This study used an approach based on a series of five cognitive tests to determine whether a client should continue driving, undergo further evaluation, or stop driving. The series of tests were used to classify drivers as safe, indeterminate, or unsafe. In principle, a driver would take the second test only if the driver was classified as indeterminate on the basis of first test, and so on. By applying the tests in sequence, few drivers should remain classified as indeterminate at the end of the series of tests. This serial approach has the potential to streamline the decision-making process for occupational therapists by classifying the more extreme unsafe cases while still providing an accurate assessment of cognitive fitness to drive.

This study used an approach based on a series of five cognitive tests to determine whether a client should continue driving, undergo further evaluation, or stop driving.

Importance: Persons with Parkinson’s disease (PD) become more dependent in activities of daily living (ADL) as the disease progresses. Occupational therapy practitioners aware of the stages of PD can design interventions to promote and maintain occupational performance.

Objective: To evaluate the ADL independence and dependence profiles of patients with PD on the basis of disease stages.

Design: Retrospective observational study.

Setting: Hospital in Japan.

Participants: Patients with PD (N = 209; 75 men and 134 women), with a mean age of 73.3 yr (SD = 7.7).

Outcomes and Measures: The Hoehn and Yahr (H-Y) stage was used to determine patients’ disease severity. The Barthel Index (BI) was used to determine independence in performing ADLs.

Results: In the H-Y Stage 2 group, the prevalence of independence in mobility and stairs was low, whereas that in other ADLs was high. In the H-Y Stage 3 group, more than half of the patients had limitations in bathing, mobility, and navigating stairs, although most patients remained independent in other ADLs. In the H-Y Stage 4 group, more than half of the patients required assistance with most ADLs, except feeding and bowel control. In the H-Y Stage 5 group, the prevalence of independence during feeding and grooming was relatively high.

Conclusions and Relevance: Dependence in ADL domains differs by PD stage, with direct implications for occupational therapy intervention.

Plain-Language Summary: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms and nonmotor symptoms. The disease progression can gradually affect activities of daily living (ADLs), which can lead to decreased independence and quality of life as well as increased caregiver distress. This study evaluated the ADL independence and dependence of patients with PD based on each patient’s disease stage. The study found that ADL dependence differs based on the PD stage (mild, moderate, severe), with direct implications for occupational therapy intervention. Occupational therapists can design interventions to improve and maintain the occupational performance of people with PD. Interventions that target ADLs should be based on the patient’s PD stage.

This study evaluated the activities of daily living independence and dependence of people with Parkinson’s disease based on each person’s disease stage.

Importance: Single-case designs (SCDs) offer a powerful research methodology for demonstrating the effectiveness of occupational therapy interventions for diverse clients with individualized needs. However, the current state of the use of SCDs in occupational therapy remains unclear.

Objective: To summarize the current state of and challenges associated with the use of SCDs in occupational therapy.

Data Sources: Articles were retrieved from the following databases: PubMed, Web of Science, PsycINFO, OTDBASE, and CINAHL. Related articles were manually searched to identify relevant studies, with the publication year restricted to 1990 to 2023.

Study Selection and Data Collection: This scoping review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The search terms used were occupational therapy, single-case design, and synonyms for single-case design. The search was restricted to journals specifically dedicated to occupational therapy.

Findings: Eighty-eight studies met the inclusion criteria for this review. Existing research has focused on the practice areas of children and youth and physical disabilities or rehabilitation. Moreover, AB designs, ABA designs, and visual analysis that do not meet the What Works Clearinghouse standards are frequently used as research methods.

Conclusions and Relevance: Although SCDs can be highly useful in demonstrating the effectiveness of occupational therapy interventions for diverse clients with individualized needs, considering the quality of SCDs when designing studies is crucial.

Plain-Language Summary: This scoping review delved into the current landscape and challenges of single-case designs (SCDs) in occupational therapy. The findings revealed the pervasive adoption of low-quality designs and the predominant use of visual analysis methods in this field. In light of these findings, it is imperative for future research and development efforts to embrace established guidelines, paving the way for enhanced methodological rigor and robust outcomes.

This scoping review summarizes the current landscape and challenges of single-case designs (SCDs) in occupational therapy.

Importance: Poststroke patients have insufficient voluntary movement that is usually accompanied with spasticity, weakness, and abnormal muscle coactivation. A dynamic spring-loaded orthosis was designed to assist patients’ finger movements via a steel wire spring, but relevant evidence for muscle contractions by electromyographic (EMG) activity while the orthosis is worn is lacking.

Objective: To explore muscular activity and muscular coactivation during orthosis use.

Design: A 2 (orthosis condition: wearing vs. free) × 2 (hand condition: affected side vs. unaffected side) mixed repeated-measures experimental design.

Setting: Rehabilitation clinic.

Participants: Thirty participants with a diagnosis of stroke were enrolled.

Outcome and Measures: The surface EMG of the flexor digitorum superficialis (FDS) and extensor digitorum common (EDC) was recorded in isometric and dynamic tasks. Two dependent variables, normalized electromyography (nEMG) and cocontraction index (CCI), were calculated.

Results: The nEMG of the EDC and FDS of the affected side were significantly higher in the wearing condition than in the free condition. The nEMG of the EDC of the affected hand was significantly higher than that of the unaffected hand during dynamic activities but not during isometric activities. CCI was significantly lower on the affected side than on the unaffected side in the wearing condition.

Conclusions and Relevance: Muscular contraction significantly increased during dynamic orthosis use. The efficacy of the dynamic orthosis in muscle strength training (concentric resistance training of finger flexors and eccentric resistance training of finger extensors) for stroke patients was supported.

Plain-Language Summary: People who have experienced a stroke have insufficient voluntary movement that is usually accompanied by spasticity, weakness, and abnormal muscle coactivation. This study explored muscular activity and muscular coactivation for stroke patients using a dynamic spring-loaded hand orthosis that was designed to assist patients’ finger movements via a steel wire spring. The study found that muscular contraction significantly increased when the dynamic orthosis was worn than when it was not worn during grasp-and-release tasks. The study results support the efficacy of the dynamic orthosis in muscle strength training for stroke patients. Dexterous movement improvements will contribute to achieving functional independence for poststroke patients.

The study results support the efficacy of a dynamic orthosis in muscle strength training for stroke patients.

Importance: Complications of Type 2 diabetes mellitus (T2DM) leading to vision loss may increase the risk of dementia. The relationship between diabetic retinopathy severity and visual acuity (VA) has been explored, but the impact of dementia on vision-related functional performance in patients with T2DM is less understood.

Objective: To investigate the association of diabetes-related eye problems with dementia and the impact of dementia on vision-related quality of life (VRQoL) and activities of daily living (ADLs) in patients with T2DM.

Design: Retrospective cohort and nested case-control study.

Setting: Health care institution.

Participants: Substudy 1 included 4,454 patients with T2DM. In Substudy 2, 33 patients with T2DM and dementia (male, n = 15; M age = 78.7 yr) were compared with 67 matched control participants (male, n = 36; M age = 76.6 yr).

Outcomes and Measures: Patients with and without dementia were assessed with the 25-item National Eye Institute Visual Function Questionnaire (NEI–VFQ 25) and the Revised Self-Report Assessment of Functional Visual Performance (R–SRAFVP).

Results: Substudy 1 showed a borderline significant association between proliferative diabetic retinopathy and dementia. In Substudy 2, functional vision, particularly in the overall scales and three subscales of the R–SRAFVP and four subscales of the NEI–VFQ 25, declined significantly among patients with T2DM and dementia, but no significant differences were found in VA.

Conclusions and Relevance: The findings illustrate the complex relationships among T2DM, dementia, VRQoL, and vision-dependent ADL and suggest that occupational therapists who care for patients with T2DM and dementia should pay close attention to patients’ functional vision.

Plain-Language Summary: Complications of Type 2 diabetes mellitus (T2DM) that lead to vision loss may increase the risk of dementia. People with T2DM and dementia show a significant decline in functional vision. This study investigated the relationship between diabetes-related eye problems and dementia as well as the impact of dementia on vision-related quality of life and activities of daily living for patients with T2DM. The study demonstrates the complex relationships among dementia, T2DM, eye conditions, and vision-related function. The results highlight the importance of a functional vision assessment for patients with T2DM and dementia. Occupational therapists who care for patients with T2DM and dementia should pay close attention to patients’ functional vision, which will guide them in assessment and intervention planning.

This study investigated the relationship between diabetes-related eye problems and dementia as well as the impact of dementia on vision-related quality of life and activities of daily living for patients with Type 2 diabetes.

Importance: Widely used for assessing levels of disability, the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) provides informative profiles for six life perspectives. However, its utility is constrained by its lengthy assessment time, decreasing respondents’ willingness to complete it.

Objective: To address the utility challenge by developing a computerized adaptive testing system of the WHODAS 2.0 (CAT–WHODAS 2.0) for people with dementia.

Design: Fit indices were analyzed for a multidimensional Rasch model. The consistency of item difficulties was examined for the score comparability for examinees across sexes. The best set of stopping rules was determined using simulations to achieve high reliability and efficiency simultaneously.

Setting: Community.

Participants: The responses of 3,124 people were obtained from a nationwide database for disability certification, assessed through interviews.

Results: Twenty-seven items exhibited satisfactory model fits (infit and outfit mean squares = .58–1.35), and no items demonstrated differential item functioning by sex (difference values = −0.07 to 0.04). With the best set of rules, the CAT–WHODQAS 2.0 required approximately nine items to provide high Rasch person reliabilities in the six domains. These reliabilities were similar to those of the item bank (.90–.91 versus .93–.96). The concurrent validity was excellent: Pearson’s rs = .90–.94 with the raw domain scores and .96–.99 with item bank.

Conclusions and Relevance: The CAT–WHODAS 2.0 can provide efficient, reliable, valid, and sex-unbiased assessments of disability for people with dementia. It may serve as an alternative for clinicians and researchers to optimize the efficiency of data collection.

Plain-Language Summary: This article presents the computed adaptive testing of the World Health Organization Disability Assessment Schedule 2.0 (CAT–WHODAS 2.0) as an efficient solution to provide reliable, valid, and sex-unbiased assessments of disability among people with dementia. The CAT–WHODAS 2.0 is a promising alternative for clinicians because it can efficiently assess a person’s level of disability with extremely high reliabilities in the six domains of functioning (cognition, mobility, self-care, getting along, life activities, and participation). The CAT–WHODAS 2.0 is also useful for researchers because its scores are comparable with those of the item bank, which consists of 27 items calibrated by the Rasch model.

This article presents the computed adaptive testing of the World Health Organization Disability Assessment Schedule 2.0 (CAT–WHODAS 2.0) as an efficient solution to provide reliable, valid, and sex-unbiased assessments of disability among people with dementia.

Importance: Neurogenic bladder can negatively affect quality of life for children with incomplete spinal cord injury. Occupational therapy practitioners are uniquely able to provide individualized care to address this, which may include external pelvic floor biofeedback.

Objective: To describe the implementation of external pelvic floor biofeedback for bladder management within the context of toileting for children with neurogenic bladder dysfunction following incomplete spinal cord injury.

Design: Retrospective case series.

Setting: Inpatient rehabilitation unit within a pediatric hospital.

Participants: Three children with incomplete spinal cord injury were enrolled.

Intervention: External pelvic floor biofeedback.

Outcomes and Measures: The study used the Functional Independence Measure for Children (WeeFIM^®), Activity Measure for Post-Acute Care (AM-PAC) Daily Activities Short Form, Pediatric Spinal Cord Injury Activity Measures (PEDI–SCI AM) Short Forms, and voiding characteristics.

Results: No adverse events occurred. Following biofeedback, all children improved their AM-PAC toileting scores, and PEDI–SCI AM scores improved for 2 of 3 children, whereas daily catheterization requirements decreased for all children. The WeeFIM did not detect changes in bladder management for 2 of 3 children.

Conclusions and Relevance: This case report described how occupational therapy practitioners used external pelvic floor biofeedback as an adjunct conservative treatment strategy when providing care for pediatric children with recent incomplete spinal cord injury.

Plain-Language Summary: Neurogenic bladder dysfunction following incomplete spinal cord injury can negatively affect a child’s quality of life and social participation. Occupational therapy practitioners are uniquely able to address bladder management within the context of toileting for children with acquired incomplete spinal cord injury. A multimodal approach, which includes biofeedback, may improve the child’s level of independence with toileting.

This case report describes how occupational therapy practitioners used external pelvic floor biofeedback as an adjunct conservative treatment strategy when providing care for pediatric children with recent incomplete spinal cord injury.

Importance: Because handwriting is fundamental to academic success and early literacy development, it is crucial to identify letter formation difficulties. The Letter Form Assessment Version 2 (LFA–2) was developed to measure letter formation fluency but requires validation.

Objective: To examine the LFA–2’s interrater reliability, construct validity (factor structure), and concurrent validity.

Design: Observational cross-sectional analysis of data from a longitudinal study.

Setting: School.

Participants: Seventy-eight kindergarten students in Australia (41 boys, 37 girls; M age = 68.5 mo, SD = 4.2) were recruited for construct and concurrent validity studies. A subgroup (n = 16) was used for interrater reliability testing.

Results: Interrater reliability for LFA–2 total was excellent (interclass correlation coefficient = .96, 95% confidence interval [.90, .98]). Interrater agreement coefficients for individual letters scores were good to excellent (Cohen’s κ = .71 to 1.00; Gwet’s AC1 = .79 to 1.00). Factor analysis established unidimensionality with good total score reliability (ω = .92). Correlations of the LFA–2 total score were moderate to strong with timed and untimed alphabet writing (r_s  = .32 and r_s  = .36, respectively), visual–motor integration (r_s  = .55), fine motor precision (r_s  = .35), and manual dexterity (r_s  = .34; all ps < .01).

Conclusions and Relevance: Preliminary findings support the LFA–2’s reliability and validity for assessing letter formation fluency among beginning writers. Multiple raters using the LFA–2 were reliable in their use of the tool (interrater reliability), and item structure was confirmed to be unidimensional (construct validity). The LFA–2 performed as expected compared with other measures (concurrent validity). Research on larger samples is required to verify these results.

Plain-Language Summary: Handwriting is an important skill in early education and supports the development of reading and writing skills. To write by hand efficiently, children need to develop movement patterns that allow them to form letters correctly and from memory. Children can advance their literacy skills once they can perform these letter formation patterns automatically. There are limited assessments of beginning writers’ letter formation patterns, making it difficult for occupational therapists and teachers to identify children who need more help with their early handwriting. A new tool, the Letter Form Assessment Version 2 (LFA–2), has been developed to address this need. This study presents the first results of the development and validation of the LFA–2.

This study presents the first results of the development and validation of the Letter Form Assessment Version 2 (LFA–2) to measure letter formation fluency among beginning writers.

Importance: Family accommodation of anxiety disorders is associated with poorer outcomes; therefore, they are important to detect. A child’s sensory problems often cause anxiety and disrupt family routines, which can increase family accommodation.

Objective: To compare family sensory accommodation among children with autism spectrum disorder (ASD), children with sensory overresponsiveness (SOR), and typically developing children (TD). To examine the role of parenting distress tolerance in explaining the relation between SOR and family accommodation.

Design: Cross-sectional case control design involving nonrandomized sampling and a survey methodology.

Setting: Internet.

Participants: Parents of 57 ASD children, 54 SOR children, and 48 TD children. Groups were matched on child age and ethnicity.

Outcomes and Measures: The Short Sensory Profile 2, Adapted SensOR Inventory (total SOR), Family Accommodations Scale for Sensory Over-Responsivity (FASENS), and the Parenting Distress Tolerance Scale (P–DTS).

Results: The groups with ASD or SOR (clinical groups) had a higher frequency of family sensory accommodation, and these accommodations showed greater interference with child and family well-being than among the TD group. The clinical groups had significantly more bothersome sensations and lower P–DTS scores than the TD group. In the clinical groups, the P–DTS mediated the relation between total SOR and FASENS scores, controlling for mother’s years of education.

Conclusions and Relevance: Family sensory accommodation was more frequent among families of children with ASD or SOR and interfered more with child and family well-being. For clinical groups, being bothered by more sensations reduced parenting distress tolerance, which increased family accommodation.

Plain-Language Summary: When children have strong reactions to sensory experiences, families often change their routines to prevent discomfort. This is called family sensory accommodation—when family members adjust their behaviors to avoid or minimize their child’s sensory challenges and the associated distress. Although this may reduce stress in the short term, it can also reinforce anxiety and limit a child’s ability to cope. We found that parents of children with autism spectrum disorder or sensory overresponsiveness were more likely to make these accommodations compared with parents of typically developing children. These accommodations were linked to greater disruptions in both child and family well-being. We also found that parents who had more difficulty managing their own stress were more likely to engage in family sensory accommodation. These findings highlight the need for occupational therapists to support families in reducing restrictive accommodations while helping children build independence and coping skills.

The study findings highlight the need for occupational therapists to support families in reducing sensory accommodations while helping children with autism spectrum disorder build independence and coping skills.

Importance: Collaboration between occupational therapists and family caregivers is essential during home assessments and modifications. The shift to videoconferencing-based assessments suggests increased family caregiver involvement, but the specifics of this change are unclear.

Objective: To investigate family caregiver involvement during videoconferencing-based home assessments and subsequent modifications from the perspective of occupational therapists.

Design: This descriptive qualitative study involved virtual, semistructured individual interviews with participants who were recruited through purposeful and snowball sampling. Data analysis followed a descriptive thematic analysis methodology with an inductive approach.

Setting: All interviews were conducted virtually at each participant’s preferred time and location.

Participants: Fifteen occupational therapists from the Veterans Health Administration (VHA) with experience in videoconferencing-based home assessments and subsequent modifications for rural veterans.

Results: Four key themes were identified: (1) increased active involvement of family caregivers during the home assessment process, (2) circumstances that require family caregiver involvement for videoconferencing, (3) family caregiver–related factors affecting outcomes, and (4) strategies for effective family caregiver involvement.

Conclusions and Relevance: The findings suggest that veterans’ family caregivers play a more active role during videoconferencing-based home assessments than they do during traditional in-person assessments. This increased involvement may lead to a higher workload for VHA occupational therapists, who should now train caregivers, and for family caregivers themselves, who need to perform tasks previously handled by occupational therapists during home visits. To address this challenge, occupational therapists can leverage the insights extracted from this study.

Plain-Language Summary: Occupational therapists often collaborate with family caregivers to assess the safety and accessibility of clients in their homes, recommending changes to the home environment accordingly. However, occupational therapy practitioners do not fully understand how much family caregivers are involved in videoconferencing-based home assessments, which is a new remote method, and subsequent modifications to client interventions. In this study, we explored, through interviews with 15 occupational therapists from the Veterans Health Administration (VHA), how family caregivers are involved in videoconferencing-based home assessments and subsequent modifications that are made to client interventions. We found that family caregivers have a greater responsibility for additional tasks during videoconferencing compared with traditional in-person assessments, including conducting measurements typically handled by occupational therapists. This understanding will help VHA occupational therapists adjust their practices to improve service delivery and reduce the workload for both occupational therapists and family caregivers.

Through interviews with occupational therapists from the Veterans Health Administration with experience in videoconferencing-based home assessments, this study explored family involvement in the assessments and subsequent home modifications.

Importance: School-based occupational therapists are well positioned to provide oral feeding management, yet understanding of how they can effectively address oral feeding goals in school systems is limited.

Objective: To evaluate the current role of occupational therapy in pediatric oral feeding management in school-based settings.

Evidence Review: The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews was used as a guide. Six databases (CINAHL, Medline, PsycINFO, Embase, Web of Science, and Google Scholar) and four search engines (Bing, Google, Yahoo, and Ask.com) were searched with the keywords feeding, school, and occupational therapist. Studies with the following criteria were included: written in English, services provided in a school setting, children from junior kindergarten to Grade 12, and the management of oral feeding by occupational therapists in schools.

Findings: An initial 189 articles were generated, and 10 articles met the eligibility criteria after elimination of duplicate studies and title and abstract screening. Four areas emerged regarding the role of occupational therapy in feeding in schools: (1) using a multidisciplinary collaborative approach to support students with feeding needs; (2) offering assessment strategies that range from informal to standardized methods; (3) implementing various intervention techniques, but evidence is limited, and (4) formalizing policies to include feeding goals in students’ individual education plans, although the process for doing so remains unclear.

Conclusions and Relevance: The field of occupational therapy needs more evidence-based practice, more training in oral feeding management, and updated policies for oral feeding management in schools.

Plain-Language Summary: Occupational therapists are well positioned to support the feeding needs of children in schools. This scoping review identifies four key roles for occupational therapists: collaborating with multidisciplinary teams to address feeding issues, conducting assessments from informal to standardized methods, providing a range of intervention strategies, and advocating for formal policies that incorporate feeding goals into students’ individual education plans to better manage oral feeding challenges in the school setting.

This scoping review identifies key roles for occupational therapists in supporting the feeding needs of children school settings.

Importance: Advanced cancer treatments have led to more people wanting to return to work but are unable. Occupational therapists have the skills to address impaired person and environmental factors delaying return to work.

Objective: Describe a three-phase occupational therapy return-to-work intervention based on the Person–Environment–Occupation–Performance (PEOP) model.

Design: Case series.

Setting: Outpatient clinic.

Participants: Adults with brain cancer (N = 3) who completed or were undergoing cancer treatment and wanted to return to work.

Intervention: We evaluated a three-phase occupational therapy approach focusing on restoring self-care skills and advocacy (Phase 1), understanding job demands and developing prework skills (Phase 2), and providing return-to-work support (Phase 3).

Outcomes and Measures: Employment status was based on patient self-report. Pre- and postintervention measurements were the 10-item Weekly Calendar Planning Activity; five times sit-to-stand test; Patient Health Questionnaire–9; Saint Louis University Mental Status Examination; Trail Making Test, Dynavision D2 Vision Training System assessment, Bell’s Test, and peripheral vision screen.

Results: Each patient returned to work and demonstrated improvements in cognition, physical, mobility, and work-related skills. One transitioned from work to permanent disability after working 8 mo.

Conclusions and Relevance: The three-phase occupational therapy approach, based on the PEOP model, considers cognitive and physical impairments and environmental and occupational demands to support persons with brain cancer return to work. The findings provide preliminary support for occupational therapy’s involvement within the cancer care continuum to support return to work.

Plain-Language Summary: Advances in cancer treatments have led to higher numbers of people with cancer who want to return to work but are unable, leading to financial stress and a reduced personal identity. This case series illustrates how three patients with brain cancer returned to work after participating in a tailored three-phase occupational therapy intervention. Each patient improved their cognitive, physical, mobility, and work skills after completing a three-phase occupational therapy program using rehabilitation and compensatory interventions. Phase 1 focused on restoring self-care skills and teaching about workplace policies. In Phase 2, the patients developed skills that reflected their unique job demands. The occupational therapist provided return-to-work support during Phase 3. These findings provide preliminary support for occupational therapy’s early involvement within the cancer-care continuum to support returning to work.

This case series illustrates how three patients with brain cancer returned to work after participating in a tailored three-phase occupational therapy intervention.

Importance: The role of occupational therapy in the rehabilitation of adults with persistent postconcussion symptoms (PPCS) following mild traumatic brain injury is an emerging practice area. Research that contributes to growing knowledge and understanding of the profession’s role may increase the recognition and visibility of occupational therapy in concussion rehabilitation programs.

Objective: To identify and categorize (using World Health Organization International Classification of Functioning, Disability and Health [WHO ICF] One-Level Classification domains) existing literature that describes occupational therapy practice (including assessments and interventions) in the rehabilitation of adults with PPCS.

Data Sources: Five scientific databases (MEDLINE, Embase, Emcare, PsycINFO, and CINAHL Complete) and gray literature were searched.

Study Selection and Data Collection: Eligibility criteria included publications between 2013 and 2023, written in English, and within the peer-reviewed literature or on specified web domains (.gov, .edu, or .org).

Findings: Nineteen publications from 16 sources met eligibility criteria, consisting of quantitative studies (n = 6); case studies, series, or reports (n = 3); qualitative studies (n = 2); systematic or scoping literature reviews (n = 2); and gray literature sources (n = 3). The United States was the origin for many sources (n = 10). Assessments and interventions reported were heterogenous, mapping across 27 of the 30 WHO ICF One-Level Classifications.

Conclusions and Relevance: Evidence to inform occupational therapy practice in adult PPCS rehabilitation is limited; however, some useful information about the assessments and interventions used by occupational therapists was found. At a time when considerable advancements in concussion rehabilitation are occurring, further research on evidence-informed occupational therapy practice is required.

Plain-Language Summary: This study reviewed existing evidence about the role of occupational therapy in the rehabilitation of adults with persistent postconcussion symptoms (PPCS). It identifies and methodically documents a range of occupational therapy assessments and interventions described in the literature that may be used by occupational therapists within concussion rehabilitation programs or research. The study also categorizes these by using an internationally recognized taxonomy, the World Health Organization’s International Classification of Functioning, Disability and Health. The review offers a novel synthesis of published evidence to guide occupational therapy practice and inform resource allocation in concussion rehabilitation. It also highlights the need for further research about the role of occupational therapy—including both high-quality evidence of current approaches and identification of future practice opportunities—in the rehabilitation of adults experiencing PPCS following brain injury.

This study reviewed existing evidence about the role of occupational therapy in the rehabilitation of adults with persistent postconcussion symptoms (PPCS).

Importance: Stroke rehabilitation in clinic- and home-based settings may yield differential effects on motor and functional outcomes.

Objective: To investigate the effects of mirror therapy preceding augmented-reality therapy in the clinic and home setting.

Design: Single-blinded, randomized crossover study.

Setting: Rehabilitation clinics and home environment of participants.

Participants: Thirty-one stroke survivors.

Intervention: Participants were randomized to receive clinic-based practice first or home-based practice first. The intervention involved mirror therapy–primed augmented-reality practice. Participants received nine treatment sessions, with a 3-wk washout period between two phases.

Outcomes and Measures: Outcome measures included the Fugl-Meyer Assessment Scale of Upper Extremity (FMA–UE), Berg Balance Scale (BBS), Chedoke Arm and Hand Activity Inventory, Motor Activity Log (MAL), and Stroke Impact Scale (SIS).

Results: Clinic-based practice significantly improved the FMA–UE (p = .04), BBS (p = .01), and SIS Mobility domain scores (p = .05). Home-based practice showed a trend for better performance on the MAL. Clinic-based practice revealed retention of treatment gains at the 3-mo follow-up assessment on the FMA–UE (p = .01) and the Activities of Daily Living–Instrumental Activities of Daily Living (p = .01), Mobility (p = .02), and Hand Function (p = .03) domains of the SIS.

Conclusions and Relevance: Clinic-based practice improved motor and balance deficits, whereas home-based practice may enhance functional arm use. Practice setting is relevant for consideration in stroke rehabilitation.

Plain-Language Summary: Research supports the benefits of using augmented reality in stroke rehabilitation. Stroke rehabilitation that includes mirror therapy has also shown promising benefits. This study investigated the effects of using mirror therapy before augmented-reality therapy to improve motor and balance after a stroke. Stroke survivors participated in sessions in either a clinic- or a home-based setting. The results showed that the clinic-based sessions led to more improvements in motor and balance, whereas the home-based sessions improved patients’ use of the affected arm in real-life situations. The findings suggest the need to take into consideration the occupational therapy practice setting as part of stroke rehabilitation. Clinic- and home-based practice may complement each other to optimize the effects of stroke rehabilitation.

This study investigated the effects of using mirror therapy before augmented-reality therapy to improve motor and balance in stroke rehabilitation.

Importance: Adults with disabilities remain vastly underrepresented in work roles, which contributes to additional financial, health, well-being, and social disparities. Innovative, disability justice–informed solutions are needed to bridge knowledge-to-practice gaps and improve the participation of adults with disabilities in meaningful employment.

Objective: To explore the impact of an evidence-based, occupational therapist–led professional development workshop to improve knowledge of, skills in, and attitudes toward implementing disability-inclusive workplace practices.

Design: Mixed-methods, pre–post quality improvement project.

Setting: A secure online video communication platform.

Participants: All employees of a global corporation were invited to participate. Ninety-seven participants were recruited via nonprobability convenience sampling.

Intervention: A live, open-group, 60-min virtual workshop session informed by disability justice and occupational therapy frameworks with synchronous learning activities and assessments.

Outcomes and Measures: An adapted version of the Theoretical Domains Framework survey, informal open-ended surveys to capture participants’ understandings of disability, an informal survey of performance analysis skills, and a qualitative survey to obtain post-session feedback were administered.

Results: Considerable improvements were noted across self-reported knowledge, skills, positive emotions, and positive perceptions of disabled inclusive workplace strategy implementation. Major themes in responses to programming included increased empathy, gaining knowledge and skills, reporting engaging content, and finding a disability-inclusive community.

Conclusions and Relevance: Participation in disability justice and occupational therapy–informed programs may improve disabled and nondisabled business professionals’ knowledge of, skills in, and attitudes toward disability-inclusive workplaces. Occupational therapy practitioners may serve as peers and leaders in large corporate environments.

Plain-Language Summary: This study explored the impact of an evidence-based development workshop led by an occupational therapist to improve knowledge of, skills in, and attitudes toward implementing disability-inclusive workplace practices. Employees of a global corporation were invited to participate in a 60-min virtual workshop. On the basis of employee responses, the study found considerable improvements across self-reported knowledge, skills, positive emotions, and positive perceptions of implementing programs designed with occupational therapy and disability justice principles. Major themes from the employee responses included increased empathy, gaining knowledge and skills, reporting engaging content, and finding a disability-inclusive community. These findings suggest that programs designed with occupational therapy and disability justice principles may help bridge knowledge-to-practice gaps. Such solutions may offer business professionals and leaders the tools and perspectives needed to better support disability-inclusive workplaces. These more inclusive work environments may secondarily support more equitable disability work participation. This study also highlights the value of occupational therapy practitioners in interprofessional settings beyond health care, including large corporate environments.

This study explored the impact of an evidence-based development workshop led by an occupational therapist to improve knowledge of, skills in, and attitudes toward implementing disability-inclusive workplace practices.

Importance: Debate over the evidence for Ayres Sensory Integration^® (ASI) is ongoing; previous reviews have reached mixed conclusions.

Objective: To evaluate the efficacy of ASI for children, based on a systematic review of randomized controlled trials (RCTs).

Data Sources: Searches of the Cochrane Library, MEDLINE, CINAHL, PsycINFO, and Embase databases.

Study Selection and Data Collection: We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RCTs were published in peer-reviewed English-language literature and compared implementation of ASI with its Fidelity Measure™ with children ages 0 to 12 yr with treatment as usual, other treatment, or no treatment. Data were extracted using the Template for Intervention Description and Replication Checklist; risk of bias was assessed with the Cochrane risk-of-bias tool for randomized trials.

Findings: Nine RCTs (N = 344 participants), six with autistic children and three with other child populations, were included. RCTs were categorized as Level 1b (well designed) or 2b (low quality); strength of evidence was determined according to U.S. Preventive Services Task Force guidelines. Strong evidence from five RCTs (four Level 1b) indicates that ASI supports autistic children in meeting their individualized goals. Moderate evidence from three RCTs (two Level 1b) indicates no benefits of ASI for behaviors of concern, such as noncompliance or irritability. Bias concerns persist among included studies.

Conclusions and Relevance: ASI supports autistic children’s individualized goals related to occupational performance, function, and participation. It is not recommended to address behaviors of concern, such as resistance to change or irritability. More research is needed to determine ASI’s benefits for other child populations.

Plain-Language Summary: Debate over the uses of Ayres Sensory Integration^® (ASI) with children accessing occupational therapy is ongoing. Previous systematic reviews used varied and inconsistent definitions of ASI interventions, included mixed methodologies of various quality, and arrived at mixed conclusions. This review addressed these concerns by focusing exclusively on high-level studies of ASI that adhered to the ASI Fidelity Measure™, providing valuable insights into the outcomes of ASI for children (age 0–12 yr). When ASI was conducted under fidelity, the evidence suggested that autistic children significantly improved in their individualized goals related to occupational performance, function, and participation. Research that included outcomes related to behaviors of concern, such as noncompliance or irritability, indicated no benefit of ASI. Emerging evidence reveals some functional and developmental benefits for autistic children and other child populations; further research is needed to support the observed outcomes.

To address concerns regarding previous reviews that used varied and inconsistent definitions of ASI interventions and arrived at mixed conclusions, this review focused exclusively on high-level studies of ASI that adhered to the ASI Fidelity Measure.

Importance: Current barriers exist that affect occupational therapy students’ and practitioners’ ability to understand statistical methods and translate knowledge into their clinical work.

Objective: To determine which statistical methods are most commonly used in the occupational therapy literature and, consequently, which methods are most critical to include in occupational therapy curricula to equip students to be better consumers of occupational therapy literature and implement evidence in practice.

Design: A thorough analysis of 1,223 journal articles across 13 core occupational therapy journals. The most common statistical methods from the core journals were recorded.

Outcomes and Measures: The frequencies and percentages of each statistical method that were reported were calculated, and the top 25 statistical methods were ranked.

Results: The analysis revealed that the top statistical methods included descriptive statistics, t tests, confidence intervals, χ², effect size, analysis of variance, parametric correlations, Cronbach’s α, post hoc analysis and pairwise comparisons, and thematic analysis and coding.

Conclusions and Relevance: The study determined the top 25 statistical methods used in the core occupational therapy literature. Occupational therapy educational programs can use this study as guidance for the inclusion of statistical content in their respective programs.

Plain-Language Summary: This study was conducted to determine which statistical methods are most commonly used in occupational therapy research. We reviewed 13 key occupational therapy journals and identified the 25 most frequently used methods. These results can help improve how statistics is taught in occupational therapy programs.

This study identified the most commonly used statistical methods in occupational therapy research.

Importance: Supporting acquired brain injury (ABI) survivors to find new vocational roles is a critical aspect of vocational rehabilitation. However, it is rarely provided in the United Kingdom and U.K.-based research in this area is lacking.

Objective: To characterize the new vocational roles obtained by ABI survivors who accessed a specialist service (Working Out program) providing rehabilitation and supported employment.

Design: Retrospective descriptive statistical analysis of routinely collected clinical data.

Setting: Community Head Injury Service, Buckinghamshire Healthcare National Health Service Trust, United Kingdom.

Participants: ABI survivors who accessed the Working Out program between 2005 and 2023 and who started a new vocational role during this period.

Outcomes and Measures: Role type, role status, industry.

Results: ABI survivors (N = 278; M age = 41.75 yr, SD = 13.09; 24.82% female) obtained a new vocational role. It took on average 1.98 yr (SD = 2.35, range = 0–14) to find an initial new role. Survivors obtained on average 2.79 new vocational roles each (SD = 2.13, range = 1–15). Of the 767 roles for which relevant data were available, 332 (43.29%) were paid, 386 (50.33%) were voluntary, and 49 (6.39%) were education or training roles. The most frequent industry in which a new vocational role was obtained was administrative and support service activities.

Conclusions and Relevance: U.K. ABI survivors may be supported to find new vocational roles. However, rehabilitation plus supported employment interventions may be required for an extended duration given the complexity of ABI as a chronic health condition and challenges associated with finding new roles.

Plain-Language Summary: People with brain injuries often need support to find new vocational roles after their injury. However, this type of support is rarely provided in the United Kingdom, and U.K.-based research in this area is limited. We analyzed data from a U.K. clinical service that provides rehabilitation and helps people with brain injuries find new jobs. We showed that many people with brain injuries successfully found at least one new job, and many of these new jobs were paid. However, it often took a substantial period of time for them to find a new job.

This study analyzed outcomes data from a U.K. clinical service that provides vocational rehabilitation to people with an acquired brain injury.

Concussions are prevalent in youth and often contribute to occupational challenges related to postconcussion syndrome within the educational setting. Despite the advancements that have been made in the occupational therapy management of concussion, school-based occupational therapy practitioners are seeking clarity in service delivery because there is no clear framework that guides service provision for postconcussed youth within the educational setting. In this column, we emphasize the role of school-based occupational therapists as an existing source of support within the school structure, describe school-based occupational therapy as a viable service for postconcussed youth, and highlight a feasible framework that can be applied to service delivery within the educational setting to support the recovery of postconcussed youth.

This column emphasizes the role of school-based occupational therapists as viable support for postconcussed youth.