American Journal of Occupational Therapy最新文献

Importance: Occupational therapy practitioners need modern tools for the assessment of maximal grip strength in clinical and remote settings.

Objective: To establish the (1) interrater reliability and (2) precision of the GripAble among three raters with different expertise in occupational therapy when testing healthy participants, and to (3) evaluate the relative reliabilities of different approaches to estimating grip strength (i.e., one trial, mean of two trials, and the mean of three trials).

Design: Measurement study.

Setting: Minnesota Translational Musculoskeletal and Occupational Performance Research Lab, University of Minnesota, Minneapolis.

Participants: Thirty volunteers, age ≥18 yr, without any hand problems.

Outcomes and measures: Using GripAble, three occupational therapy raters with varied experience measured the maximal grip strength of the dominant and nondominant hands of all participants. Using the mean of three trials when testing grip strength with GripAble adds precision.

Results: GripAble has excellent interrater reliability (i.e., intraclass correlation coefficient > .75) and acceptable precision (minimal detectable change < 15%) among healthy adults.

Conclusions and relevance: GripAble allows occupational therapy practitioners with different experiences to assess grip strength in healthy hands quickly, precisely, and with excellent reliability. Additional research is needed on its psychometrics in clinical populations and capacities in remote monitoring and exergaming. Plain-Language Summary: The results of this study show that grip strength, an important biomarker and commonly assessed construct in occupational therapy, can be evaluated reliably, precisely, and rapidly with GripAble. The use of GripAble by occupational therapy practitioners in clinical settings may help to build an infrastructure for remote measurements and exergaming interventions in the future.

Importance: As identified in the American Occupational Therapy Association's (AOTA's; 2023) statement about the purpose and value of the occupational therapy doctoral capstone, there is a lack of evidence about the purpose and value of the doctoral capstone. As an essential element of occupational therapy doctoral degree curricula, the capstone is unique to each program, supports the program's scholarship agenda, and serves the needs of students and the communities served by the profession.

Objective: To develop a doctoral capstone research agenda in an attempt to prioritize and guide research that can supplement the current paucity of evidence related to capstone efficacy or effectiveness.

Method: The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were used to conduct a scoping review. Peer-reviewed articles published between 1999 and June 2023 were searched using the CINAHL, PsycINFO, PubMed, and Embase databases.

Results: The doctoral capstone research agenda was developed and organized into five categories to drive research activities inclusive of the didactic and experiential learning associated with the planning, implementation, and evaluation of the capstone process: (1) teaching and learning; (2) learner characteristics and competencies; (3) shaping professional identity; (4) faculty/mentor development and resources; and (5) promotion of diversity, equity, and inclusion.

Conclusions and relevance: A doctoral capstone research agenda was developed in accordance with AOTA's (2018) Occupational Therapy Education Research Agenda. It identifies an array of areas in which research is needed to inform the distinct value and purpose of the doctoral capstone to students, sites, programs, and the profession. Plain-Language Summary: The occupational therapy doctoral capstone is unique to each program, supports the program's scholarship agenda, and supports the needs of students and the communities served by the profession. The American Occupational Therapy Association's official document on the "Occupational Therapy Doctoral Capstone: Purpose and Value" states that there is a lack of evidence about how to identify the distinct purpose and value of the doctoral capstone. This scoping review explored the development of a doctoral capstone research agenda. A research agenda is provided to guide and prioritize research to articulate best practices and the distinct purpose and value of the doctoral capstone in occupational therapy education and for the profession.

Importance: Sleep disorders are associated with a range of health conditions, with poor sleep often further exacerbating individuals' health, well-being, and ability to participate in daily occupations. Weighted blankets offer a potentially simple nonpharmacological sleep intervention option.

Objective: To summarize available literature on instrumentation and outcomes associated with overnight use of weighted blankets for therapeutic purpose.

Evidence review: A scoping review following the PRISMA review guidelines was conducted. Sources included MEDLINE, Cochrane Library, CINAHL, PsycINFO, Scopus, Embase, and Google. Included studies reported on overnight use of weighted blankets. Critical appraisal of studies was conducted with standardized tools.

Findings: Eighteen studies met the inclusion criteria. Positive outcomes were reported for adults, including improved sleep, reduction in medication use, and improved mood. Sleep outcomes were mixed for children and adolescents but included improved occupational performance. Methodological quality of included studies regarding effectiveness was variable. Ten studies included details of the intervention, whereas only one study reported on implementation. No specific guidelines for use were included.

Conclusions and relevance: Weighted blankets are used as a sleep intervention for individuals across the life span experiencing a range of health conditions. Currently, there is more evidence of effectiveness with adults, although parents are favorable regarding weighted blanket use for children. Implementation and recommendation of weighted blankets are typically led by occupational therapists, with knowledge of the intervention facilitating use. This review provides information to inform occupational therapists' clinical decision-making and continued implementation of weighted blankets for individuals with sleep problems. Plain-Language Summary: This scoping review summarizes what is known about the use of weighted blankets as a sleep intervention for people of all ages. There is more evidence for overnight use of weighted blankets for adults, with improvements reported in sleep, mood, medication use, and pain. Although there is little evidence of improvement in sleep for children, some children show improvement in everyday functioning, and parents report positive outcomes from overnight use of weighted blankets. These findings suggest that occupational therapists should consider offering or recommending weighted blankets as a sleep intervention option for people of all ages, alongside consideration of individuals' preferences. Development of practice guidelines that incorporate current research findings is urgently needed to support occupational therapists' use of weighted blankets.

Importance: There is a need for a pediatric hand function test that can be used to objectively assess movement quality. We have developed a toy-based test, the Bead Maze Hand Function (BMHF) test, to quantify how well a child performs an activity. This is achieved by assessing the control of forces applied while drawing a bead over wires of different complexity.

Objective: To study the psychometric properties of the BMHF test and understand the influence of age and task complexity on test measures.

Design: A cross-sectional, observational study performed in a single visit.

Setting: Clinical research laboratory.

Participants: Twenty-three participants (ages 4-15 yr) were recruited locally. They were typically developing children with no illness or conditions that affected their movement. Interventions/Assessments: Participants performed the BMHF test and the Box and Block test with both hands.

Outcomes and measures: Total force and completion time were examined according to age and task complexity using a linear mixed-effects model. We calculated intraclass correlation coefficients to measure interrater reliability of the method and estimated concurrent validity using the Box and Block test.

Results: Total force and completion time decreased with age and depended on task complexity. The total force was more sensitive to task complexity. The Box and Block score was associated with BMHF completion time but not with total force. We found excellent interrater reliability.

Conclusions and relevance: A familiar toy equipped with hidden sensors provides a sensitive tool to assess a child's typical hand function. Plain-Language Summary: We developed the Bead Maze Hand Function (BMHF) test to determine how well a child performs an activity with their hands. The BMHF test is a toy equipped with hidden sensors. Twenty-three typically developing children with no illnesses or conditions that affected their hand movement participated in the study. We asked the children to perform the BMHF test with both hands. Our study found that occupational therapists can reliably use the BMHF test to assess a child's hand function.

Importance: Patient-reported outcome measures provide insights into intervention effects on patients. The Canadian Occupational Performance Measure (COPM) emphasizes identifying priorities in daily activity engagement and evaluating an individual's perception of changes over time.

Objective: To assess the responsiveness of the COPM and the minimal clinically important difference (MCID) among patients with frozen shoulders.

Design: Prospective, single-blind, randomized controlled trial.

Setting: Two physical medicine and rehabilitation clinics.

Participants: Ninety-four patients with frozen shoulders enrolled in a previous study.

Outcomes and measures: Baseline and 3-mo evaluations of the COPM and other measures. Responsiveness was assessed using effect size (ES) and standardized response mean (SRM). The MCID values were determined through a distribution-based approach, which used the 0.5 standard deviation and ES methods, and an anchor-based approach, which used the receiver operating characteristic curve method.

Results: The ES and SRM results indicated that the COPM had high responsiveness. The distribution-based MCID values for COPM Performance and COPM Satisfaction were 1.17 and 1.44, respectively. The anchor-based MCID values were 2.5 (area under the curve [AUC] = 0.78, 95% confidence interval [CI] [0.64-0.91]) and 2.1 (AUC = 0.76, 95% CI [0.60-0.91]), respectively.

Conclusions and relevance: The findings suggest that the COPM is a responsive outcome measure for patients with frozen shoulder. The established MCID values for the COPM can be valuable for interpreting changes in patient performance and satisfaction, thus aiding clinical interventions and research planning. Plain-Language Summary: This is the first study to review the effectiveness of the Canadian Occupational Performance Measure (COPM) to determine the success of occupational therapy interventions for people with a frozen shoulder. The findings suggest that the COPM is an effective and valuable tool for clients with a frozen shoulder to understand their experiences and treatment priorities and to detect meaningful changes in their performance and satisfaction after an occupational therapy intervention.

Importance: Although research has examined early identification of autism spectrum disorder (ASD), few studies have found behavioral markers during midinfancy associated with later ASD diagnosis.

Objective: To examine infants' play behaviors and atypical positions at age 6 mo and later outcome classification among infants at elevated likelihood (EL) and typical likelihood (TL) for ASD. Atypical positions refer to movement patterns indicative of motor delays or deviations, including atypical extension and flexion, poor weight shift and rotation, hypertonicity or hypotonicity, and the presence of primitive reflex patterns.

Design: Observational cohort longitudinal design using blinded video analysis.

Participants: Fifty-eight infants (41 EL infants and 17 TL infants) 6 mo of age.

Results: Infants later diagnosed with ASD needed more support to engage in play at age 6 mo compared with infants who did not receive an ASD diagnosis (U = 130, z = -2.29, p < .05, r = .31). Atypical positions at 6 mo of age were not associated with a later diagnosis of ASD.

Conclusions and relevance: Play behaviors may be early indicators of developmental differences for infants later diagnosed with ASD. The results of this pilot study suggest the need to observe the quality of interaction with a caregiver and objects during early play, which may serve as potential early indicators of ASD. Plain-Language Summary: Few studies have found behavioral markers during midinfancy that are associated with a later diagnosis of autism spectrum disorder (ASD). The results of this study showed that infants who were later diagnosed with ASD were found to have differences in play behaviors compared to infants who were not later diagnosed with ASD. Thus, early play behaviors may be an early indicator of developmental differences for infants who are later diagnosed with ASD.

Importance: Ayres Sensory Integration® is an evidence-based, manualized occupational therapy intervention for autism that is delivered in person. A telehealth adaptation could bridge service gaps for families who may have challenges accessing services.

Objective: To create a telehealth adaptation of the evidence-based manualized protocol of Ayres Sensory Integration using best practice for telehealth guidelines and to obtain input on the adaptation from experts.

Setting: Online survey of U.S. telehealth experts and occupational therapy clinicians in fall and winter 2022.

Participants: Two telehealth experts and six occupational therapy clinicians.

Outcomes and measures: Two Qualtrics surveys focused on perceived feasibility and acceptability, resources included, and clarity of instructions.

Results: Telehealth experts and occupational therapy clinicians rated the Ayres Sensory Integration telehealth adapted manual as easy to follow, aligned with telehealth best practices, and feasible for remote delivery. Suggestions for additional adaptations included adding resources for technology troubleshooting, intervention planning, rapport building, and continuing education.

Conclusions and relevance: Suggested adaptations were made; the manual is ready for feasibility testing. Plain-Language Summary: This report is the first to describe a telehealth adaptation of Ayres Sensory Integration®. The manual provides comprehensive training and resources to support clinicians in delivering sensory integration, telehealth-based interventions to autistic children. Two telehealth experts and six occupational therapy clinicians rated the Ayres Sensory Integration telehealth adapted manual as easy to follow, aligned with telehealth best practices, and feasible for remote delivery. The manual will be available to clinicians after feasibility and pilot testing.

Importance: The transactions between the physical environment and children's play have not been well studied. The theory of affordances provides a way to better understand how environmental characteristics offer opportunities for play occupation.

Objective: To investigate the relationship between environmental characteristics of outdoor play spaces and children's outdoor play and to develop an environmental taxonomy to support the analysis of play affordances in community play spaces.

Data sources: Peer-reviewed literature (1974-2023) was sourced from a previously published scoping review (Morgenthaler, Schulze, et al., 2023). The Academic Search Complete, Avery Index to Architectural Periodicals, CINAHL, MEDLINE, PsycINFO, Scopus, and Web of Science databases were searched using the keywords and synonyms of playground, environmental qualities, and children with and without disabilities.

Study selection and data collection: A secondary analysis of the previously published scoping review was conducted. Included studies were those that provided descriptions of physical environment-play activity transactions.

Findings: A qualitative content analysis of 45 articles was conducted and used to form an environmental taxonomy. This taxonomy consisted of 14 space and object categories defined by their functional qualities and linked to play affordances. An array of 284 play occupations were identified in different forms. Play affordances of spaces and object categories and their functional environmental qualities were subsequently identified.

Conclusions and relevance: This study provides evidence to support the understanding of how the physical environment shapes children's outdoor play occupations. Plain-Language Summary: The study authors developed the Environmental Taxonomy of Outdoor Play Space Features as a tool that occupational therapists can use to better understand and describe how the physical environment shapes opportunities for play. The tool could also be useful to justify environmental intervention in schools and public playgrounds to create spaces that support more play for a diversity of children.

Importance: Parent recall is the primary method for measuring positioning practices such as tummy time in infants. Concerns regarding the accuracy of parent recall have been raised in the literature. To date, no study has examined the agreement of tummy time recall measures with gold-standard methods.

Objective: To assess the agreement between parental recall versus direct observation of tummy time in infants, and to explore the impact of prematurity on this relationship.

Design: Cross-sectional observational study, spanning 1 yr.

Setting: Participants' homes Participants: Thirty-two infant-parent dyads (19 full-term, 13 preterm), with infants ages 3 to 6 mo and caregivers ages older than 18 yr.

Outcome and measures: Home-recorded videos of infant play across 3 days were used as a proxy for direct observation of tummy time and compared with a 12-item parent recall survey.

Results: Parent recall had a significant moderate correlation (ρ = .54, p = .002) with direct observation in full-term infants but was not correlated (p = .23) with direct observation in preterm infants. On average, parents of preterm infants overestimated tummy time by 2.5 times per day compared with direct observation.

Conclusions and relevance: For full-term infants, parent recall measures of tummy time exhibit an acceptable level of agreement with direct observation and can be reliably used over shorter periods. Parents of preterm infants may display a bias in recalling tummy time, leading to overestimations. To accurately assess tummy time in this population, a combination of subjective and objective measures should be explored. Plain-Language Summary: Tummy time is an essential movement experience for infants, especially for preterm infants, who are at a higher risk for motor delays. The most common way to track tummy time is through parent reports, or recall, versus a practitioner directly observing tummy time in the home. Despite the widespread use of parent recall to track tummy time, no study has examined the accuracy of parent recall versus direct observation in the home. Accurately assessing tummy time is crucial for improving and supporting health outcomes for infants. This study found that prematurity may affect the accuracy of parent recall for assessing tummy time in young infants. The authors discuss the implications of this finding and provide suggestions to guide the selection of appropriate methods to measure tummy time in clinical practice and research studies.

Importance: A response shift (RS) is a phenomenon in which there is an individual perceptual gap between pre and post assessments. RS effects were not considered in the Canadian Occupational Performance Measure (COPM) development process.

Objective: To detect the effects of RS on the COPM.

Design: Convergent mixed-methods research.

Setting: Subacute rehabilitation hospital in Japan.

Participants: Nineteen adult patients with a range of neurological and musculoskeletal conditions recruited from a subacute rehabilitation hospital.

Outcomes and measures: In the qualitative analysis, patients' perceptions regarding occupation identified by the COPM were compared between the initial assessment (Time 1 [T1]) and a reassessment (Time 2 [T2]). In the quantitative study, patients were asked to re-rate the occupations in which the RS had occurred, giving feedback on their perceptions at T1 (T2'). The difference between T2 and T2' was calculated to clarify the magnitude of the RS.

Results: Of the 19 patients, 18 had an RS in at least one occupation. The RS effects were classified into five categories: Replacing, Adding, Reducing, Unspecified, and Embodiment. Ninety occupations were extracted from all the patients, and 46 (51.1%) were affected by RS. The percentages of occupations for which the change in score due to RS exceeded the minimal clinically important difference (±2 points) was 26.1% (12 of 46) for COPM-Performance scores and 30.4% (14 of 46) for COPM-Satisfaction scores.

Conclusions and relevance: Diverse RS effects have been identified in the COPM, which also affect score interpretation. Plain-Language Summary: The Canadian Occupational Performance Measure has a potential measurement bias that is due to a response shift in which there is an individual perceptual gap between pre and post assessments. The results of this study reveal a need to establish more accurate measurement methods to reduce the impact of response shifts on COPM scores.