American Journal of Occupational Therapy最新文献

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.

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.

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

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

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.

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.

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.

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 occ

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, bu