American Journal of Occupational Therapy

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Importance: Lateral elbow pain (LEP) is associated with damage to the accessory rotator muscles of the forearm, but there is little evidence of the effect of LEP on pronosupination torques and its influencing factors.

Objective: To analyze the differences in forearm pronosupination torques between affected and sound limbs in patients with LEP and to investigate the influence of sex, age, dominance, and forearm position.

Design: A cross-sectional study, using a stepwise selection algorithm for analysis of variance, to assess torque variations on the basis of the considered factors.

Setting: Biomechanical analysis laboratory in a university research institute.

Participants: A convenience sample of 36 people with LEP, predominantly middle-aged, with a majority presenting with dominant upper limb involvement.

Outcomes and Measures: Torque measurements for pronation and supination in multiple forearm positions.

Results: Participants had significant deficits in pronosupination torques in affected limbs compared with sound limbs, particularly in extreme positions. The largest differences were observed in the supination direction with 60° of forearm pronation and the pronation direction with 60° of forearm supination. Sex and dominance significantly influenced torque production, but age did not.

Conclusions and Relevance: The greatest values and differences in torque between sound and affected limbs occurred for extreme rotations of the forearm opposite to the direction of the movement, with significant amplifications on torque reduction for the affected side, nondominant limb, and female patients. Those results can be used to define assessment methods and to design training and evaluation methods that address relevant strength deficits of patients affected by LEP.

Plain-Language Summary: Understanding the torque profiles of pronation and supination in lateral elbow pain can provide insights into functional impairments and guide occupational therapy rehabilitation strategies as well as progressive reincorporation into certain activities of daily living and work-related manual tasks. Our findings highlight the importance of assessing forearm movement in rehabilitation settings and emphasize the need for targeted interventions that focus on pronosupination function in patients with lateral elbow pain.

The study findings highlight the importance of assessing forearm movement in rehabilitation settings and emphasize the need for targeted occupational therapy interventions.

Importance: Handgrip testing is highly valid and reliable, but the high cost of dynamometers limits their use in some settings. A more affordable option, the Camry dynamometer, has recently been used in fitness surveillance; however, its reliability and validity compared with known weights and well-validated models remain unknown.

Objective: To investigate test–retest reliability, intermodel reliability (new vs. old Camry), and interinstrument reliability (Camry vs. TKK dynamometer) and concurrent validity of the Camry dynamometer by using calibrated known weights.

Design: Comparison study with a digital TKK 5401 dynamometer and two Camry EH101 dynamometers (new and old, with more than 3,000 uses).

Outcomes and Measures: Intrainstrument and interinstrument reliability and concurrent validity were assessed to compare measures of the dynamometers with calibrated weights using the Bland–Altman method.

Results: Intrainstrument (retest minus test) reliability was very high (systematic error for test–retest reliability): new Camry, M = 0.01 kg (SD = 0.49); old Camry, M = –0.10 kg (SD = 0.49); TKK, M = 0.14 kg (SD = 0.76). Comparison showed small mean differences between Camry dynamometers and TKK (new Camry vs. TKK, M = 0.84 kg, SD = 0.79; old Camry vs. TKK, M = 0.88 kg, SD = 0.85). The mean systematic error between the new and old Camry dynamometers was 0.03 kg (SD = 0.57). Concurrent validity showed smaller magnitude systematic errors in the Camry than TKK: new Camry, M = –0.21 kg (SD = 0.35); old Camry, –0.18 kg (SD = 0.79); TKK, M = –1.07 kg (SD = 0.75).

Conclusions and Relevance: The Camry dynamometer is highly reliable and valid and is a more affordable alternative for handgrip strength assessment.

Plain-Language Summary: Handgrip strength is an important measure of health and is linked to outcomes such as overall mortality and illness. Testing handgrip strength is useful for health and fitness-related professionals, including occupational therapists, to track rehabilitation progress. However, the cost of the dynamometers limits their use in some places or large-scale studies. Recently, a cheaper alternative, the Camry dynamometer, has been used, but its accuracy compared with known weights or other validated devices has not been confirmed. This study tested the reliability and accuracy of two Camry dynamometers (a new and an old device) versus the TKK dynamometer and known weights. Results showed that the Camry dynamometer is highly reliable, valid, and durable and remains accurate even after many uses. The findings could make handgrip strength testing more accessible in health care and fitness evaluations.

This study found that the Camry, a low-cost handgrip dynamometer, is highly reliable, valid, and durable and remains accurate even after many uses.

Importance: Occupational therapy practitioners provide interventions to adults with pressure injury (PI) in their home. However, little is known about these adults’ experiences of living with PI in the home environment. Current guidelines are biomedically focused and based on research primarily in hospital or institutional settings.

Objective: To synthesize experiences from qualitative studies of people living at home with PI.

Data Sources: Six databases were searched (CINAHL, ProQuest Central, Scopus, Cochrane Reviews, MEDLINE, and Embase).

Study Selection and Data Collection: Qualitative studies examining experiences of adults with PI living at home, published in English from 2000 to 2024, were included. Two researchers independently screened records for eligibility by title and abstract and by full text. Experiences were extracted from the studies and analyzed thematically.

Findings: Of the 2,245 records identified, 14 reporting experiences of living with PI at home met the inclusion criteria and were included. Six overarching themes described these experiences: (1) living with occupational deprivation; (2) living with pain, smell, and sleep deprivation; (3) living with fear, anxiety, and uncertainty; (4) finding ways to cope with grief and loss; (5) learning health self-efficacy and occupational balance; and (6) sharing the journey with health professionals.

Conclusions and Relevance: Guidelines for practitioners working with adults with PI at home are urgently needed. Occupational therapy practitioners can intervene by supporting engagement in meaningful occupation, preventing occupational deprivation, and promoting occupational balance, particularly for adults requiring bedrest or activity restriction. Research should be expanded to include adults with cognitive impairment and palliative disease, children, and rural residents.

Plain-Language Summary: This study aimed to understand the experiences of adults living at home with pressure injury because current guidelines are hospital focused. The study found that different guidelines are needed for care at home. Adults living with pressure injury at home are limited in their activities and experience pain, smell, sleep deprivation, anxiety, and uncertainty. They need to cope with grief, take charge of their health, and balance activity with rest. Health professionals can improve well-being by having definite home visit times, ensuring smooth and continuous care, and helping adults make their own decisions about pressure injury care. Occupational therapy practitioners should support meaningful activities, balance activity and rest, and match assistive technology to home needs. Alternatives to bedrest are needed, and pain and sleep issues need to be addressed. This study helps occupational therapy practitioners better understand the experiences of people living with a pressure injury at home and calls for more research with people with cognitive impairment or palliative conditions, as well as with children and people living in rural settings.

This systematic review helps occupational therapy practitioners better understand the experiences of people living with a pressure injury at home.

Importance: Cognitive impairment is a common and disabling feature of Parkinson’s disease (PD), and interventions to mitigate its negative functional consequences are in high demand. Metacognitive strategy interventions, such as the Multicontext (MC) Approach, may support daily function among people with PD (PwPD).

Objective: To determine feasibility, participant acceptance, and preliminary estimates of the MC Approach’s treatment effect for PwPD.

Design: Quasi-randomized controlled pilot trial. Participants underwent pretreatment assessment, allocation to treatment group (MC, n = 29; control, n = 28), 10 treatment sessions, 1-wk posttreatment assessment, and 3-mo questionnaire follow-up.

Setting: Participants’ homes.

Participants: PwPD without dementia but with subjective cognitive concerns.

Intervention: Ten weekly sessions of the MC Approach, which aimed to develop awareness and strategies to control cognitive performance across activities via therapist mediation, functional activity performance, and homework. The control intervention used the same structure and treatment activities but did not address awareness or strategy use or use mediated learning.

Outcomes and Measures: Indicators of trial feasibility (recruitment, retention, study duration), participant acceptance (satisfaction, homework completion), and treatment effect (self-rated functional cognitive goal performance).

Results: We enrolled 3 participants/mo and had 87% retention. Both groups’ satisfaction and homework completion were high. Compared with control participants, MC participants reported greater improvement in functional cognitive goal performance from preintervention to postintervention that was maintained at follow-up.

Conclusions and Relevance: The MC Approach is a feasible, acceptable, and potentially efficacious intervention to address the functional cognitive goals of PwPD without dementia. A larger, fully randomized trial is required to provide definitive efficacy data.

Plain-Language Summary: Cognitive impairment is one of the most common and disabling features of Parkinson’s disease. As such, cognitive interventions that support daily function for this population are in high demand. The purpose of this study was to establish the feasibility of one such potential intervention, the Multicontext (MC) Approach, among people with Parkinson’s disease (PwPD) without dementia. We also wanted to generate preliminary estimates of its effect on everyday cognitive function to inform future definitive trials. In a pilot quasi-randomized controlled trial, we found that the MC Approach is feasible, safe, and acceptable for people with PwPD. We also found that it may improve self-rated performance of daily cognitive goals. We can now proceed with a full-scale randomized controlled trial to determine its efficacy. Ultimately, this work will meet the pressing need for evidence-based cognitive interventions that improve or maintain occupational performance and participation among PwPD.

The purpose of this study was to establish the feasibility of the Multicontext Approach, a cognitive intervention for people with Parkinson’s disease without dementia.

Importance: Stroke survivors commonly report persistent sleep disruptions during rehabilitation and postrecovery. Despite little research that explores the impact of stroke on a patient’s chronotype, no studies have explored the differences in cognitive performance between treatment timing fitted and nonfitted to the patient’s chronotype.

Objective: To characterize the sleep chronotype in patients in the subacute poststroke period, to explore cognitive task performance differences during fitted and nonfitted hours, and to examine the relationships between sleep quality and cognitive performance.

Design: Cohort design.

Setting: Health care institution.

Participants: Twenty men and women (M  age = 60.2, SD = 8.6) post–first stroke.

Outcomes and Measures: The following measures were collected twice, during fitted and nonfitted chronotypic times: demographic surveys, the Munich Chronotype Questionnaire, the Montreal Cognitive Assessment (MoCA), the Rivermead Behavioral Memory Test, Second Edition (RBMT–2), a fatigue questionnaire, and of actigraphy for 4 to 5 days.

Results: Stroke survivors exhibited an earlier sleep chronotype postinjury compared with preinjury. Enhanced memory (higher RBMT–2 scores) occurred during fitted hours. No significant differences emerged in executive functions, attention tasks, and MoCA scores between fitted and nonfitted hours. The Wake After Sleep Onset index correlated with the MoCA and RBMT–2 scores during fitted hours (MoCA: r = .53, p = .021; RBMT–2: r = .51, p = .027). Number of awakenings correlated with the MoCA letter task during nonfitted hours (r = .45; p = .044).

Conclusions and Relevance: Occupational therapy practitioners should be aware of the relationship between chronotype and cognitive performance, with a focus on the importance of personalized rehabilitation strategies in stroke care.

Plain-Language Summary: The timing of cognitive assessments poststroke can influence their reliability, particularly when considering a patient's chronotype (sleep cycle). For instance, if a morning person is evaluated later in the day (nonfitted to their chronotype), the results may indicate greater cognitive decline compared with scores they might achieve in the morning. In our study, we assessed cognitive performance twice: once fitted to the patient’s chronotype and once not. Our findings revealed that memory function significantly improved during evaluations conducted at personalized times. This suggests that occupational therapy practitioners who evaluate patients during nonoptimal times may prescribe a more extensive rehabilitation plan than necessary.

The study findings revealed that memory function for stroke survivors significantly improved during cognitive assessments conducted at personalized times, highlighting the importance of personalized occupational therapy rehabilitation strategies.

Importance: Limited research exists examining the long-term impact of a parent-mediated responsive feeding intervention on children’s mealtime skills and behaviors and caregiver stress and competence.

Objective: To examine children’s changes in mealtime skills and behaviors and to examine caregiver stress and competence.

Design: A nonrandomized repeated-measures study.

Setting: Home-based.

Participants: Twenty-five children who received more than 10% of their calories through tube feeding and from their parents.

Intervention: Caregivers participated in a home-based responsive feeding intervention directed at changing caregiver–child interactions during mealtimes. After receiving general caregiver education, interventions were delivered three to five times daily for 10 days, followed by 6 mo. of coaching sessions as needed.

Outcome and Measures: Clinical measures and the Children’s Eating Behaviour Questionnaire were used to measure mealtime skills and behaviors. The Parent Stress Index–Short Form–4 and the Parent Sense of Competence Scale were used to measure caregiver competency and stress.

Results: Seventeen caregivers completed the assessment battery for at least five of the six time points. All participants reduced tube use. Significant differences existed in children’s mealtime skills and behaviors over time with continued improvement with follow-up coaching. Caregivers continued to feel stressed while their competence improved.

Conclusions and Relevance: The intervention was effective at helping children transition to oral feeding and develop oral motor skills. It was not effective at reducing caregiver stress.

Plain-Language Summary: This study was conducted to determine whether responsive feeding interventions can help children who are tube fed learn to eat by mouth and develop skills. The results from this study support therapy feeding interventions that target caregiver–child interactions. It also suggests that children with motor impairments can still improve chewing, biting, utensil use, and hand use by participating in motivating and relevant activities. These improvements can occur with continued coaching only. The study showed that children’s mealtime skills and behaviors continued to improve after the intense intervention stopped and with coaching only. Caregivers may feel stressed about children’s eating, despite successful intervention. Occupational therapists who work with tube-fed children should focus interventions on caregiver–child interactions. Therapists should also monitor caregiver stress and mental health, even if the child learns to eat well.

The results of this study support occupational therapy feeding interventions that target caregiver–child interactions.

Importance: Identity Development Evolution and Sharing (IDEAS) is an evidence-supported occupational therapy intervention for reducing provider stigma to promote health care equity. Its effectiveness relies on successful implementation. It is therefore critical to identify and examine key difference-makers that facilitate or impede implementation success and effectiveness.

Objective: To determine difference-making conditions for the successful implementation of IDEAS in occupational therapy settings.

Setting: Occupational therapy sites.

Participants: Internal facilitators, occupational therapy staff, and site managers or stakeholders at nine clinical sites (N = 58).

Outcomes and Measures: The data sources included interviews generated using the Consolidated Framework for Implementation Research, to assess key implementation constructs; three validated ratings scales (the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure); and the Acceptance and Action Questionnaire–Stigma, a valid and reliable measure of enacted stigma, to assess intervention effectiveness. Coincidence analysis was used to identify difference-makers directly linked to implementation success and effectiveness.

Results: Two implementation-related factors were identified as key difference-makers: design quality and packaging and impact of external facilitation. Sites with successful IDEAS implementation had either a strong positive value for design quality and packaging or a lower positive value for design quality and packaging bundled together with a strong positive value for impact of external facilitation.

Conclusions and Relevance: In addition to identifying effective evidence-based interventions to improve clinical practice, occupational therapy practitioners and their clients also stand to gain through a careful consideration of how implementation factors influence the success of evidence-based practices in real-world settings.

Plain-Language Summary: This study looks at how to successfully use a program called Identity Development Evolution and Sharing (IDEAS) in occupational therapy settings. IDEAS is a training that helps reduce bias and stigma among health care providers by sharing real stories from people who have experienced discrimination in health care. Bias in health care can lead to unfair treatment and poor outcomes for people receiving health care. Reducing this bias is essential for making health care more fair and inclusive. Occupational therapists want to support equity, but they need effective tools and strategies to do so. IDEAS is one such tool, but it only works well when certain conditions are present. The researchers studied how IDEAS was used in nine occupational therapy clinics across the United States. They looked at what helped or hurt the success of the program, using a method called coincidence analysis to find out which variables made the biggest difference. Two key things helped make IDEAS successful: (1) design quality and packaging (how well the training materials were put together and how easy they were to use) and (2) external facilitation (support from an outside expert who trained and guided the person who led IDEAS in their clinic). If either of these was strong, the program worked well. If both were strong, it worked even better. Other variables such as a positive impression of the IDEAS program and a receptive workplace culture were also related to how well the IDEAS program worked. Occupational therapists who want to reduce bias in their practice can use IDEAS more effectively by making sure the training materials are clear and easy to use, getting support from someone experienced with the program, and creating a workplace culture that is open to learning and change.

This study looks at how to successfully use a program called Identity Development Evolution and Sharing (IDEAS) in occupational therapy settings.

Importance: Standardized evidence-based cognitive assessments, including functional cognitive assessments, are key to the identification of cognitive impairments and provision of occupational therapy services.

Objective: To explore the current practices related to cognitive assessments and barriers to their use in acute care and inpatient rehabilitation occupational therapy services.

Design: We used a cross-sectional, qualitative approach that included five focus groups conducted with occupational therapy practitioners and key informant interviews with occupational therapy supervisors (n = 5). Data were analyzed by two coders using an inductive content analysis approach.

Setting: Acute care and inpatient rehabilitation hospitals.

Participants: Occupational therapy practitioners (N = 31).

Results: Customary cognitive assessment included use of self- and proxy report measures, neurocognitive screening tools, and skilled observation. Use of standardized tests, including performance-based tests (PBTs), was limited. Barrier-related themes endorsed by most participants included organizational pressures, accessing and using evidence, conforming to the setting’s culture, characteristics of the built environment, and assessment complexity. An outlier group that relied heavily on performance-based functional cognitive tests was identified.

Conclusions and Relevance: Current occupational therapy practice primarily consists of informal, unstandardized methods of identifying cognitive impairments. Use of standardized assessment is infrequent. Personal and organizational barriers identified were consistent with those identified in the literature. Despite endorsing identified barriers that are perceived as constraining their use, an outlier group consistently used PBTs of functional cognition. This outlier group’s negotiation of barriers presents opportunities for how to target evidence-based implementation efforts.

Plain-Language Summary: This article describes occupational therapists’ current practices related to the use of cognitive tests. We asked therapists about factors that affect their use of different types of formal cognitive tests; specifically, we looked at the use of pencil-and-paper cognitive tests versus tests that use simulated real-world activities to assess function. Occupational therapists reported many barriers to using cognitive tests of either type, including a lack of time, difficulty accessing tests, and unfamiliar tests that are hard to learn. Most therapists predominantly use informal methods of assessing client’s cognition or pencil-and-paper screening methods. One group differed in that its members mostly used formal assessments of simulated real-world tasks to evaluate the ability to perform everyday life tasks.

This article describes occupational therapists’ current practices related to the use of cognitive tests.

Background: Although substantial evidence exists regarding persistent symptoms and functional impairment in hospital settings following COVID-19, there is a noticeable lack of data on occupational participation and physical activity in community-based settings.

Objective: To compare the levels of occupational participation and physical activity among adults who had recovered from acute COVID-19 infection and those who had not recovered.

Design: Retrospective comparative cohort descriptive study.

Participants: Fifty English-speaking adults age 18 yr or older who tested positive for COVID-19 within the past 4 yr but not within the past 6 mo were enrolled, including participants who had not recovered and those who had fully recovered.

Outcomes and Measures: Measures included the Occupational Self-Assessment–Short Form and Modifiable Activity Questionnaire. Chi-square tests and independent-samples t tests were used for data analysis.

Results: Individuals who did not fully recover from COVID-19 displayed significant differences in age (p = .002), marital status (p = .026), body mass index (p = .003), and disability income (p = .034) compared with those who recovered. They also reported lower competence (p = .049) in occupational participation and spent less time (p < .001) and effort (p < .001) on occupational activities.

Conclusions and Relevance: The results confirm the Model of Human Occupation theory that physical limitations can impede a person’s daily activities and restrict their participation in more strenuous tasks. Nonetheless, this does not diminish the value of occupational participation, even if they are presently engaged in lighter indoor leisure activities.

Plain-Language Summary: The Model of Human Occupation theory highlights that occupational participation—how individuals engage in work, play, and daily activities within their social and cultural environments—is vital for well-being. After COVID-19, many people continue to face lingering symptoms, yet understanding of its effects on occupational participation and physical activity in community settings is limited. This study compared occupational participation and physical activity levels between adults fully recovered from acute COVID-19 and those still recovering. The results showed clear differences, with those not fully recovered feeling less competent in managing daily tasks and participating less in physically or mentally demanding activities. These findings suggest that rehabilitation programs should focus not only on improving physical abilities but also on addressing the psychological factors involved in returning to daily life.

This study compared occupational participation and physical activity levels between adults fully recovered from acute COVID-19 and those still recovering.

Importance: Globally, the occupational therapy profession has neglected to address the anti-Black racism in its therapeutic services. Although discussions on ethnic/racial issues have grown in the field in recent years, few studies have investigated the theoretical and methodological frameworks that inform the practices of occupational therapy practitioners who work with Black populations.

Objective: To describe and analyze the theoretical and methodological frameworks available to occupational therapy practitioners who provide services to Black populations.

Data Sources: MEDLINE, CINAHL, PsycINFO, LILACS, SCIELO, Web of Science, and Scopus were searched for articles published in English and Portuguese from 2013 to 2024.

Study Selection and Data Collection: Scoping review procedures as outlined by Arksey and O’Malley (2005) and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA–ScR) were used to identify articles that reflect theoretical and methodological frameworks that guide the practices of occupational therapy practitioners who work with Black populations.

Findings: Forty-eight articles met the inclusion criteria and were organized into four themes: humanities and social sciences: theories and frameworks; occupation-centered approaches; addressing systemic inequalities through collective occupations, intersectionality, and the incorporation of Black epistemologies into occupational therapy practices; and methodological approaches.

Conclusions and Relevance: Findings suggest that occupational therapy practitioners must adopt an antiracist approach with Black populations and be guided by counterhegemonic and decolonial frameworks. More studies are needed to investigate the effectiveness and limitations of frameworks that guide therapeutic practices with Black populations.

Plain-Language Summary: This scoping review interrogates anti-Black racism in occupational therapy practice and the relevant frameworks available to occupational therapy practitioners working with Black populations around the world. The authors identify practice and research gaps that remain in the discourse and provide pathways for action that address the needs and demands of these populations from an antiracist lens.

Positionality Statement: The authors are Black, cisgender, heterosexual, female-identifying occupational therapy practitioners and academic activists who engage in research and practice at the intersections of antiracism, gender, and ableism in occupational therapy and occupational science. The first and third authors live in different regions of Brazil and speak Portuguese. The first author is from a state in northeastern Brazil, which has the largest percentage of Black residents outside the African continent. The third author is from southeastern Brazil, a region with a significant percentage of White individuals. The second author is from the southern United States, is a native English speaker, and has practiced, taught, and conducted research with Black populations in the United States. These social markers shape how we do everyday life, being members of the Black community in our respective countries, belonging to an antiracist movement, and becoming transformative agents to change approaches to engaging with Black occupational therapy service recipients.

This scoping review interrogates anti-Black racism in occupational therapy practice and the relevant frameworks available to occupational therapy practitioners working with Black populations around the world.

Importance: Cognitive skills play a central role in a person’s independent community functioning. As a profession, occupational therapy practitioners need to understand how cognitive evaluation is incorporated into the overall provision of occupational therapy services.

Objective: To describe occupational therapy practitioners’ current practice for evaluating cognitive function in adults across treatment settings.

Design: A cross-sectional survey conducted from September 2022 to September 2023.

Setting: Web-based survey distributed through online platforms, direct e-mail invitations, and in person through flyer distribution.

Participants: Four hundred forty-six licensed occupational therapy practitioners with at least 6 mo of experience in adult treatment settings.

Results: Most occupational therapy practitioners evaluate cognition using clinical judgment rather than neurocognitive screening measures, χ²(9) = 52.39, p < .001; or functional cognitive measures, χ²(9) = 77.49, p < .001. More occupational therapy practitioners evaluate cognition using neurocognitive screening measures rather than functional cognitive measures, χ²(9) = 68.63, p < .001. The Montreal Cognitive Assessment (25.6%) was the most used standardized neurocognitive measure, and the Allen Cognitive Level Screen (15.2%) was the most widely used standardized functional cognitive measure. Various factors (e.g., time required for use, cost, ongoing peer or administrative support) were perceived to affect the selection and use of measures.

Conclusions and Relevance: Occupational therapy practitioners primarily use unstandardized methods to evaluate cognition. When standardized measures are used, neurocognitive measures were used more frequently than functional cognitive measures. Occupational therapy practitioners report that comprehensive evaluation of cognition includes information derived from a variety of sources.

Plain-Language Summary: In this study, we describe the current practices of occupational therapy practitioners for evaluating cognitive function in adults. We found that occupational therapy practitioners most often evaluate cognition using unstandardized methods. Standardized paper-and-pencil neurocognitive measures are used more often than functional cognitive measures that observe a person’s ability to perform practical real-world tasks.

The authors describe the current practices of occupational therapy practitioners for evaluating cognitive function in adults.

Importance: Joint contractures can lead to significant limitations in participation in activities of daily living and functional mobility. However, evidence regarding occupational therapy self-care interventions for children diagnosed with amyoplasia is limited.

Objective: To provide a detailed observational description of self-care-focused interventions for the pediatric population with amyoplasia.

Design: A retrospective case-series design was used to describe a week-long bout of rehabilitation completed to address functional skills.

Setting: A pediatric outpatient orthopedic specialty hospital.

Participants: Three case series participants were included. Participants were ages 7 to 15 yr, diagnosed with amyoplasia, and completed a week-long bout of therapy.

Intervention: Five 90-min visits on consecutive days, including evaluation and discharge visits, targeted occupational performance. Interventions addressed assistive technology (AT) use, caregiver education, and environmental modifications.

Outcomes and Measures: Clients completed the Canadian Occupational Performance Measure (COPM) and the FIM^® or Functional Independence Measure for Children (WeeFIM^®) at the evaluation and discharge visits to determine changes in independence in completing self-care skills.

Results: All three clients experienced improvements in independence to complete self-care skills. Participants’ COPM scores increased from evaluation to discharge. Similarly, FIM and WeeFIM scores indicated improved levels of independence related to targeted goals. It is important to note that changes in outcome measures were only assessed immediately after the therapy episode; longitudinal changes were not tracked.

Conclusions and Relevance: The findings emphasize the importance of interventions focused on AT, environmental modifications, and caregiver education to address performance of daily activities of children diagnosed with amyoplasia.

Plain-Language Summary: The case series adds evidence regarding the importance of occupational therapy in targeting self-care interventions with children diagnosed with amyoplasia. Short consecutive occupational therapy sessions may improve clients’ awareness of assistive technology and environmental modifications. A combination of low and high technology may be vital for improving occupational performance in this population. Additionally, it is important for occupational therapy practitioners to address caregiver education throughout sessions to increase carryover of skills and techniques. Practitioners working with clients with amyoplasia should understand pediatric development in addition to body functions and structures to ensure interventions are appropriate, attainable, and meaningful. This information can guide clinical interventions and occupational therapy didactic education, as well as influence future prospective studies regarding this specific population.

This case series adds evidence regarding the importance of occupational therapy in targeting self-care interventions with children diagnosed with amyoplasia.

Importance: Older drivers with impaired vision may face challenges using in-vehicle technologies, affecting user experience.

Objective: To explore use challenges with in-vehicle technologies and training preferences of older drivers with and without central vision loss (CVL).

Design: A telephone questionnaire on perceptions of driver–vehicle interface use difficulties, challenges with existing advanced driver assistance systems (ADAS), and preferences for ADAS acquisition and training.

Setting: Community-dwelling U.S. older adults.

Participants: A total of 126 volunteers 18 yr and older with valid driver’s licenses who had driven within the last 2 mo were recruited. The CVL group self-reported diagnoses of various forms of CVL.

Results: Fifty-eight older drivers with CVL (Mdn age = 71.4 yr, 41% male) and 68 without (Mdn age = 71.8 yr, 37% male) completed the questionnaire. The CVL group reported greater difficulty using in-vehicle technologies compared with the non-CVL group, particularly in recognizing visual information in vehicle interfaces. Greater difficulty correlated with poorer self-reported vision status and with increased self-regulated driving exposure. Primary challenges for the CVL group included issues with small button and font sizes, inadequate color contrast, and display glare. Both groups expressed a desire for guidance and training in effective ADAS use, with the CVL group preferring guidance from health care professionals.

Conclusions and Relevance: Older drivers with CVL face challenges using in-vehicle technologies, especially in accessing visual information. They prefer guidance from health care professionals, suggesting potential for tailored support from occupational therapists specializing in driving rehabilitation.

Plain-Language Summary: This study explored the challenges faced by older drivers with central vision loss when using in-vehicle technologies. Older drivers with central vision loss reported significantly more difficulty than drivers without central vision loss, particularly in recognizing and using visual information in vehicle interfaces and with advanced driver assistance systems. Challenges included issues with small buttons and font sizes, poor color contrast, and display glare. Individuals with more severe vision impairment, who drive less and avoid more driving situations, face more challenges with in-vehicle technologies, yet these are the drivers who might benefit most from such technologies. Both groups expressed a desire for guidance in selecting and using driver assistance technologies, with drivers with central vision loss preferring support from health care professionals. The study findings highlight the need for tailored training and support, which could enhance occupational therapy clients’ ability to effectively use modern vehicle technologies to drive safely.

The study findings highlight the need for tailored training and support for older drivers with central vision loss when using in-vehicle technologies to drive safely.

Importance: Occupational therapy can help children with myelomeningocele (CWM) maximize their independence. However, the current dose of usual-care occupational therapy services provided is unknown. Defining the dose of occupational therapy services will lay the groundwork for future intervention studies by providing a starting point for the development of intervention protocols.

Objective: To investigate the demographics and dosage (frequency, intensity, time, and type) of occupational therapy sessions for CWM and describe the usual-care outpatient hospital-based occupational therapy dosage at one institution.

Design: Retrospective cohort study.

Setting: Large urban–suburban pediatric hospital with eight outpatient clinics.

Participants: Twenty CWM, ages 0 to 18 yr (median = 4.85, interquartile range [IQR] = 3.75), receiving services from December 2021 through November 2023.

Intervention: Usual care.

Outcomes and Measures: Occupational therapy dose included frequency (total number of therapy sessions), intensity (Child Effort Rating Scale [CERS] scores), time (timed billing charges), and type (interventions and services).

Results: Participants received 258 total occupational therapy treatment sessions during the study period. Median frequency of sessions was 5.0 (IQR = 9.75). The mean CERS score was 3.01 (SD = 0.27), indicating average effort toward goals. Each therapy appointment averaged 51.87 min (SD = 7.82). Neuromuscular and musculoskeletal approaches were the most frequently used intervention type for general visits.

Conclusions and Relevance: Participants’ outpatient occupational therapy dosage at one pediatric hospital varied. This population has no dosage guidelines, and this article represents a step forward for the field by thoroughly describing the dose of usual-care therapy provided over 2 yr.

Plain-Language Summary: Occupational therapy can help children with myelomeningocele (CWM) maximize their independence. However, the current dose of usual-care occupational therapy services that are provided is unknown. This study describes the outpatient occupational therapy dose for CWM at a large hospital with multiple clinic sites. The information gathered from this study can assist occupational therapy practitioners in understanding common intervention strategies for CWM. The study results also lay the groundwork for future intervention studies by providing a starting point for the development of intervention protocols.

The information gathered from this study can assist occupational therapy practitioners in understanding common intervention strategies for children with myelomeningocele.

Importance: A combination of rehabilitation techniques may be useful to optimize individualized treatment and efficient resource utilization.

Objective: To assess the effect of cognitive therapeutic exercise (CTE) and mirror therapy (MT) combined with task-oriented training (TOT) on upper limb functionality, fine and gross motor skills, use of the paretic arm, functional independence in activities of daily living (ADLs), and quality of life among people with subacute stroke.

Design: Randomized trial, longitudinal, and multicenter study with one control group (CG) and two experimental groups (EGs) who were assessed before, after, and 3 mo posttreatment.

Setting: University of Burgos and Burgos University Hospital, Burgos, Spain.

Participants: One hundred twenty patients with subacute stroke and motor symptoms in the upper limb recruited through consecutive nonprobabilistic sampling and excluding those with tremor due to another neurological disease or cognitive impairment.

Intervention: MT + TOT (EG1) and CTE + TOT (EG2) over 20 1-hr sessions. T3he CG received usual therapy (TOT) that simulated everyday situations.

Outcomes and Measures: The studied variables were evaluated with the Action Research Arm Test, Box and Block Test, Motor Activity Log, FIM™–Functional Assessment Measure, and Stroke-Specific Quality of Life Scale.

Results: Statistically significant differences were found between the CG group and both EGs, with improvements in upper limb functionality, fine and gross motor skills, use of the paretic arm, functional independence in ADLs, and quality of life. No differences were found between EGs.

Conclusions and Relevance: Application of these combined interventions improved all variables studied.

Plain-Language Summary: This study found that the use of cognitive therapeutic exercise and mirror therapy combined with task-oriented training may improve upper limb functionality, fine and gross motor skills, the use of the paretic arm, functional independence in activities of daily living, and quality of life among people with subacute stroke.

The authors assess the effect of cognitive therapeutic exercise and mirror therapy combined with task-oriented training for people with subacute stroke.

Importance: Task-oriented circuit training (TOCT) is a structured intervention to enhance older adults’ cognitive and motor functions. However, the feasibility and effectiveness of TOCT delivered through face-to-face, telerehabilitation, and home-based methods remain unclear.

Objective: To evaluate the feasibility and preliminary efficacy of TOCT delivered through different modalities on cognitive and motor functions in older adults.

Design: A randomized feasibility study.

Setting: A state-operated skilled nursing facility in Turkey that provides daily-living assistance with on-site medical coverage for emergencies.

Participants: Fifty-four older adults (ages ≥65 yr). Inclusion criteria included Mini-Mental State Examination (MMSE) scores >18. Adults with moderate or severe impairment (MMSE scores ≤18) were excluded.

Intervention: Participants were randomly assigned to face-to-face, telerehabilitation, or home-based TOCT. They engaged in structured TOCT activities to improve joint protection, memory, attention, and fine motor skills. Sessions were delivered for 60 min daily for 2 wk. Pre- and postintervention assessments were conducted.

Outcomes and Measures: Assessments included the MMSE, the Montreal Cognitive Assessment, the Nine-Hole Peg Test, and subscales of the 36-Item Short Form Health Survey.

Results: Face-to-face TOCT showed the greatest cognitive improvements (MMSE: d = 1.52), whereas telerehabilitation improved energy and vitality levels (d = 0.91) and social functioning (d = 1.41). Home-based training showed the smallest improvements overall.

Conclusions and Relevance: TOCT through face-to-face and telerehabilitation methods effectively improved cognitive and motor functions. Face-to-face training yielded the greatest cognitive benefits, whereas telerehabilitation enhanced quality of life. Home-based interventions had limited impact. Future research should explore long-term outcomes and refine home-based programs.

Plain-Language Summary: As people age, cognitive and motor skills decline, making daily activities harder. This study examined task-oriented circuit training, a structured program delivered through face-to-face, telerehabilitation, and home-based methods. Face-to-face training showed the greatest cognitive improvements, whereas telerehabilitation enhanced energy and vitality levels and social participation. Home-based programs had minimal benefits. These findings support remote task-oriented circuit training as a viable option, although further research is needed to improve home-based interventions.

This study examined task-oriented circuit training, a structured program delivered through face-to-face, telerehabilitation, and home-based methods.

Importance: Limited evidence exists surrounding the diverse, multifaceted nature of responsibilities and challenges among school-based occupational therapy practitioners (SBOTPs).

Objective: To describe a service delivery model, feedback provision, intervention approaches, roles and responsibilities, and factors contributing to intervention decisions for SBOTPs.

Design: A descriptive electronic survey design with closed- and open-ended questions for January–March 2024.

Setting: School-based practice

Participants: Participants included 500 SBOTPs across the United States, with the majority having 10 or more years of experience (39.6%) and a master’s degree (58.9%).

Outcomes and Measures: Survey questions describing intervention approaches and frequency of use, service delivery methods, feedback provision, duties, and demographics.

Results: Most SBOTPs in elementary school provided direct intervention in therapy rooms (74.2%), whereas SBOTPs in middle and high school primarily provided consultative services (69% and 75.63%, respectively). Feedback was reported to be provided during required reports and meetings across all settings (86.27%, 88.7%, and 91.18%, respectively). The most frequently reported interventions used for SBOTPs in elementary and middle school addressed fine motor skills (98.6% and 69.5%, respectively), whereas those in high school primarily addressed life skills (56.5%). Reportedly, mental health and literacy participation were rarely addressed. Education, years of experience, and caseload size affected choices across all settings.

Conclusions and Relevance: This study clarifies the roles of U.S. SBOTPs, demonstrating how their expertise supports individual student needs and broader educational goals. By understanding and leveraging SBOTPs’ contributions, schools can better address their student populations’ diverse needs, ensuring the opportunity to succeed academically and socially.

Plain-Language Summary: This study describes a service delivery model, feedback provision, intervention approaches, roles and responsibilities, and factors contributing to intervention decisions for school-based occupational therapy practitioners. We asked 500 practitioners what interventions they use and how often, how they provide the interventions, how they communicate the child’s progress, and other tasks for which they are responsible across school settings. In elementary schools, participants said that they provide interventions in therapy rooms, whereas middle and high school practitioners consulted more with teachers and staff to support students. Our participants said that, primarily, they use fine motor and handwriting interventions in elementary and middle school but focus on developing life skills in high school. Few participants said that they address mental health or literacy, but research shows that they can and should. Many participants reported that they give feedback in required reports or meetings but wished that they had more time to provide regular feedback to students and families.

This study describes a service delivery model, feedback provision, intervention approaches, roles and responsibilities, and factors contributing to intervention decisions for school-based occupational therapy practitioners.

Importance: Occupational therapy students can experience a lack of social and academic belonging during their education, affecting their well-being and confidence. There is a lack of evidence-based programs to increase social and academic belonging.

Objective: To explore experiences of belonging and adversity among entry-level occupational therapy doctorate (OTD) graduate students and develop an ecological belonging program to address the findings.

Design: Qualitative descriptive methodology with a constructivist paradigm.

Setting: An entry-level OTD program at an urban research university.

Participants: Forty-one entry-level OTD students were recruited from a 3-yr graduate program.

Outcomes and Measures: A semistructured interview guide.

Results: Students at different stages in the entry-level OTD program participated in focus groups (n = 41). Themes illustrated that students experienced a lack of social and academic belonging at three program time points related to specific struggles they encountered. Themes included making friends, balancing school and personal life, questioning whether they belonged in occupational therapy, whether they would succeed in fieldwork, and how to excel as an entry-level practitioner. A three-session, evidence-based ecological belonging program, Supporting Hardiness and Inclusion for New Endeavors (SHINE), was developed from focus group findings.

Conclusions and Relevance: Occupational therapy students experience a lack of social and academic belonging and often feel alone in their struggles throughout graduate school. Evidence-based programs can be tailored and implemented to address this adversity. Educators can support students at key transition points to normalize adversity and encourage success.

Plain-Language Summary: This study explored the experiences of belonging and adversity among entry-level occupational therapy doctorate students. The study aimed to develop a program to normalize challenges and address self-doubt among students. Focus groups revealed that students often question their career path and experience feelings of self-doubt, especially during key transitions. These concerns extended to clinical settings, both as students and as future clinicians. The findings informed the development of an evidence-based, ecological belonging program focused on building confidence, belonging, and strategies to overcome self-doubt, helping students develop resilience for success in education and future practice.

This study explored the experiences of belonging and adversity among entry-level occupational therapy doctorate students.

Importance: Tailored smart home technology is crucial for enhancing the independence and occupational performance of individuals with physical disabilities, providing technological support for independent living.

Objective: To evaluate the effects of tailored smart home solutions on occupational performance, task performance, quality of life, and psychosocial impact and examine the efficacy of occupational therapist–led interventions.

Design: A preintervention–postintervention design to assess the impact of user-specific smart home solutions in real-world environments.

Setting: Community-based setting.

Participants: Forty individuals with physical disabilities.

Outcomes and Measures Assessments included the Canadian Occupational Performance Measure for occupational performance and satisfaction, the EuroQol–5 Dimension for quality of life, and the Psychosocial Impact of Assistive Devices Scale for psychosocial impact. Task performance across different spaces was measured on a 3-point Likert scale (1 = inability to perform, 2 = assisted performance, 3 = independent performance). Weekly monitoring evaluated usage safety and spatial safety to assess adaptation and effectiveness.

Results: After implementation of the smart home solution, participants showed significant improvements in occupational performance, quality of life, and psychosocial impact (p < .001). Task performance improved notably in key areas, including lighting control, door unlocking, and the use of electronic devices.

Conclusions and Relevance: Tailored smart home solutions, delivered through occupational therapy-based interventions, effectively enhance occupational and task performance and improve psychosocial well-being. These findings support the clinical application of smart home technologies to promote participation and independent living for individuals with physical disabilities.

Plain-Language Summary: This study demonstrates the clinical applicability of tailored smart home technology in occupational therapy interventions to promote participation and independent living for individuals with physical disabilities. Tailored smart home solutions effectively enhance occupational and task performance and improve psychosocial well-being. The findings provide a foundation for offering practical support to individuals as well as to caregivers.

Tailored smart home solutions effectively enhance occupational and task performance and improve psychosocial well-being for people with physical disabilities.

Importance: Occupational therapy practitioners play an essential role in supporting the occupational performance needs of people with osteoarthritis (OA) and rheumatoid arthritis (RA).

Objective: These Practice Guidelines aim to assist occupational therapy practitioners, educators, and researchers in applying evidence-based clinical recommendations within the scope of occupational therapy for people with OA and RA. These guidelines can also serve as a reference for people with arthritis as well as other health care professionals, health care managers, regulators, policymakers, third-party payers, and managed-care organizations.

Method: The ADAPTE methodology was the basis for the development of these Practice Guidelines. It supported efficiency by allowing us to systematically adapt existing clinical practice guidelines (CPGs) to occupational therapy practice. We selected existing CPGs for inclusion, extracted relevant evidence-based clinical recommendations, and developed associated action statements to align the recommendations with occupational therapy practice. We evaluated the quality of all the included CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE) II and AGREE–Recommendations Excellence instruments.

Results: Seven existing CPGs were included, from which 53 evidence-based clinical recommendations were extracted.

Conclusions and Relevance: Six action statements were developed related to (1) client education and self-management interventions, (2) psychosocial interventions, (3) lifestyle management interventions, (4) physical activity and exercise interventions, (5) interventions to support occupation, and (6) interventions for work participation. These statements can guide the application of the evidence-based clinical recommendations to develop personalized care solutions to support people with OA and RA so they can live well with these chronic conditions.

Plain-Language Summary: These Practice Guidelines provide strategies for occupational therapy practitioners to help people with osteoarthritis and rheumatoid arthritis live well with their chronic condition. The guidelines include specific recommendations that have been published by other professional groups. The guidelines also provide examples of how to apply these recommendations in ways that are relevant for occupational therapy practitioners. The strategies focus on educating clients with arthritis and supporting them in managing pain, fatigue, well-being, health, and participation in daily activities.

These AOTA Practice Guidelines provide strategies for occupational therapy practitioners to help people with osteoarthritis and rheumatoid arthritis live well with their chronic condition.