American Journal of Occupational Therapy最新文献

Importance: Static picture (SP) schedules are an established intervention for children with autism spectrum disorder (ASD), but the use of video modeling (VM) has not been thoroughly investigated.

Objective: To compare the effectiveness of VM prompts versus SP prompts in improving autistic children's independence with daily living skills.

Design: An experimental alternating treatment design.

Setting: Approved private school for children with disabilities.

Participants: Seventeen participants (13 male and 4 female; ages 9-18 yr) with an ASD diagnosis.

Intervention: Visual prompts using a tablet were provided during task participation, with data collected in two phases.

Outcomes and measures: Type and frequency of the prompts required to complete the task were documented for each participant during the intervention session.

Results: Both VM and SP conditions resulted in improvements in at least one phase. Most participants demonstrated a decrease in the number of required cues to complete the task and an increase in independence to complete the task. The decrease in number of cues required from baseline to end of data collection indicated clinically meaningful improvement in task completion.

Conclusion: Both VM and SP prompts resulted in an increase in independence in daily living skills, with most participants demonstrating improvement in either condition, indicating that the use of visual prompts (either VM or SP) is effective with the ASD population. Plain-Language Summary: Occupational therapy practitioners who work with autistic children and adolescents often identify improving daily living skills as a goal area. Findings from this study build on evidence that supports the use of a visual aid (either static picture or video modeling) to improve autistic children's acquisition of daily living skills. The findings also highlight emerging evidence related to the level of function and effectiveness associated with the type of visual cue. Positionality Statement: This article primarily uses identity-first language (i.e., autistic person) and at times person-first language (i.e., person with autism) to reflect the variability in the language preferences of the autism community (Lord et al., 2022).

Importance: With the increasing amount of substance use-related health conditions in the United States, it is important for rehabilitation science professionals to receive screening and prevention training.

Objective: To describe and examine the preliminary effectiveness of a novel educational program, Screening, Brief Intervention, and Referral to Treatment Plus (SBIRT-Plus), that combines traditional SBIRT training with new modules for cannabis, stimulant, and opioid use.

Design: Prospective, cohort design.

Setting: Academic institution.

Participants: One hundred eighty-one rehabilitation science graduate students.

Intervention: SBIRT-Plus curriculum.

Outcomes and measures: Outcomes included satisfaction with training, perception of interprofessional training, attitudes, knowledge, and stigma, as assessed with the Readiness for Interprofessional Learning Scale, Alcohol and Alcohol Problems Perception Questionnaire, Drug and Drug Problems Perception Questionnaire, Knowledge Screening Scale, and two stigma instruments.

Results: Most students (>80%) expressed satisfaction with their training, would recommend the training to a colleague, and believed that the training would influence and change the way they practiced with patients at risk for substance use disorders. Students' attitudes and knowledge increased from pre- to post-training, and stigma perceptions were significantly reduced.

Conclusions and relevance: SBIRT-Plus is an evidence-based interprofessional training that is feasible to implement in graduate-level education programs. Integrating SBIRT-Plus into professional graduate programs may be an optimal and low-cost model for training rehabilitation health care professionals. Plain-Language Summary: Screening, Brief Intervention, and Referral to Treatment Plus (SBIRT-Plus) is an evidence-based interprofessional training that can be easily adopted in curricula to train professional students about the importance of screening for substance use disorders.

Importance: The importance of developing age-friendly environments is globally recognized. However, few clinical trials have comprehensively evaluated physical and social components of environments and examined the effects of offering support.

Objective: To clarify the effectiveness of occupational therapy-based comprehensive environmental support for community-dwelling older adults.

Design: A single-blind parallel-groups randomized controlled trial with blinded participants.

Setting: Eight community-based settings under the long-term-care insurance system in regional towns and cities throughout Japan.

Participants: Sixty older adults age ≥65 yr who were new users of adult day care or adult day health care and allocated by stratified block randomization on the basis of age.

Intervention: Comprehensive environmental support was provided to participants for 3 mo according to results on the Comprehensive Environmental Questionnaire for older adults (CEQ) to make improvements in environmental factors participants wanted to change to create a more satisfying life.

Outcomes and measures: The primary outcome measure was the Japanese Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) score at 3 mo postrandomization. Additionally, scores on the Short-Form Six-Dimension utility index were calculated.

Results: The experimental group showed significant improvements in the SF-36's Role/Social Component Summary (p = .005) and Role-Physical (p = .02), Role-Emotional (p = .01), and Mental Health (p = .05) domains, with moderate effect sizes. The number needed to treat was 3.46, showing statistical significance.

Conclusions and relevance: Occupational therapy-based comprehensive environmental support based on CEQ scores was effective, resulting in moderate improvements in health-related quality of life among community-dwelling older adults. Plain-Language Summary: Older adults experience a decline in physical and mental functions along with changes in social relationships. These problems make it challenging for older adults to perform valuable occupations, thus reducing their quality of life. This study demonstrated that occupational therapy based on the Comprehensive Environmental Questionnaire for older adults can improve health-related quality of life among community-dwelling older adults. Our findings pave the way for the development of an effective compensatory intervention model in occupational therapy practice.

Importance: Caregivers are essential partners in caregiver-mediated interventions that build on family routines and practices. Research identifying how participation as an intervention partner influences caregivers' outcomes, including stress and self-efficacy, is scarce.

Objective: To evaluate caregiver outcomes (stress, self-efficacy, and positive feeding responses and confidence) after participation in the Engaged Eaters Program.

Design: Quasi-experimental pretest-posttest design.

Setting: In-home via telehealth.

Participants: Fourteen primary caregivers of an autistic child (ages 2-7 yr) with feeding challenges.

Intervention: The Engaged Eaters Program-Telehealth, a caregiver-mediated 6-mo in-home telehealth feeding intervention for autistic children ages 2 to 7 yr that included 24 intervention visits, eight caregiver training modules, and consultation with a dietician.

Outcomes and measures: Relationships between child feeding challenge severity and caregiver outcomes and individual differences in caregivers' intervention responses were evaluated. We assessed caregivers' stress (Parenting Stress Index, Fourth Edition Short Form), self-efficacy (Parent Sense of Competence Scale), Positive Feeding Responses and Confidence (PFRC; composite score of items from other assessments), and individual intervention response using pre- to postintervention change in scores.

Results: Exploration of individual differences revealed that only caregivers with intake PFRC scores below the mean made significant improvements by the end of the intervention. No significant group-level changes were identified for stress, self-efficacy, or PFRC. Feeding challenge severity was not significantly related to caregiver outcomes.

Conclusions and relevance: The results emphasize the importance of considering baseline practices, efficacy, and caregiver confidence when engaging caregivers in intervention. Future research should explore the nuanced relationship between caregiver outcomes and child characteristics. Plain-Language Summary: Caregivers are essential partners with feeding interventions that build on family routines and practices. When working with caregivers, occupational therapists should consider caregivers' readiness for and responses to an intervention because intervention practices may differentially affect caregivers' parenting practices, confidence, and self-efficacy. Caregivers' responses may also affect the overall effectiveness of a caregiver-mediated intervention. Positionality Statement: The term caregiver-mediated in used throughout this article in place of parent-mediated to be inclusive of all types of caregivers.

Importance: Disruption in school and the workplace are health concerns for transgender people.

Objective: To evaluate transgender individuals' thoughts and comfort with how others perceive their gender identity (social affirmation) and its association with outness in the workplace and mistreatment at work or school.

Design: Cross-sectional survey.

Participants: Survey respondents older than age 18 yr from the Study of Transition, Outcomes & Gender cohort (N = 696; n = 350 assigned male at birth, n = 346 assigned female at birth [AFAB]).

Outcomes and measures: Ever "out" to employer and treated unfairly at work or school or fired from job. Predictors were high social affirmation and comfort with how others perceive own gender identity. Descriptive statistics and logistic regression were used for analyses.

Results: Individuals reporting high social affirmation were less likely to experience mistreatment at work or school than those with low social affirmation (odds ratio [OR] = 0.57, 95% confidence interval [CI] [0.38, 0.86]). Individuals AFAB who felt comfortable with how others perceived their gender identity were less likely to be out to their employers than individuals AFAB who did not (OR = 0.45; 95% CI [0.20, 0.97]).

Conclusions and relevance: Individuals with high social affirmation were less likely to experience work or school mistreatment, and feeling comfortable with how others perceive their gender identity did not signify the need to be out. Plain-Language Summary: Occupational therapy practitioners can play a pivotal role when working with transgender individuals by assisting in creating new routines for self-presentation at work or school, navigating social environments, and providing guidance in self-advocacy skills. Individuals assigned male at birth may be in greater need because they report lower levels of social affirmation and acceptance at school and work than individuals assigned female at birth.

Importance: A sense of agency is associated with complex occupation-related responsibilities. A taxonomy can guide clinicians in enhancing responsibility in patients with Parkinson's disease (PwPD).

Objective: To (1) discover levels of responsibility in occupations for PwPD and (2) propose a taxonomy for occupations.

Design: A two-round Delphi study with PwPD and a one-round Delphi study with international experts.

Setting: Electronic survey.

Participants: PwPD (N = 75) and international experts (N = 8).

Outcomes and measures: PwPD expressed their levels of an inherent sense of responsibility for each occupation (1 = very low responsibility, 5 = very high responsibility). International experts rated their level of agreement (5 = strongly agree, 1 = strongly disagree) with each dimension of the taxonomy. A consensus was determined to have been reached if the interquartile range was ≤1 and 70% agreement in two adjacent categories was achieved.

Results: Thirty-three occupation categories were deemed as having very high to moderate responsibility for PwPD. Consequences of actions and the presence of others made up the two-dimensional responsibility taxonomy. Occupations have more challenging responsibility characteristics when they are performed with free choice, a level of high physical effort, alone, and with moral consequences.

Conclusions and relevance: This study yielded the first consensus among PwPD regarding responsibility in occupations as well as a classification system for charting the complexity of responsibility in occupations. The occupation list we have created can be beneficial to health care professionals when providing interventions or conducting outcome assessments. Plain-Language Summary: When planning interventions for patients with Parkinson's disease, it can be helpful for clinicians to be aware of patients' perspectives regarding their sense of responsibility to perform occupations. The use of a systematic sequence of challenging occupations with responsibility attributes ranging from less complex to more complex can help enhance patient occupational participation.

Importance: Community participation of autistic adults is important for health and well-being. Many clinical efforts and interventions aim to enhance community participation in this population.

Objective: To empirically examine the relationship between community participation and community mobility.

Design: A randomized controlled trial using data from baseline and 4- to 6-wk follow-up.

Setting: Community organizations serving autistic adults in Philadelphia.

Participants: Sixty-three autistic young adults with data on community mobility and participation from a prior study on public transportation use.

Outcomes and measures: Participants were tracked with GPS-enabled cell phones over a 2-wk period. A spatiotemporal data mining algorithm was used to compute the total number of destinations, nonhome destinations, unique destinations, percentage of time spent outside the home, and median daily activity space area from the GPS data. The Temple University Community Participation measure was used to collect self-report data in 21 different areas, and total amount, breadth, and sufficiency of participation were calculated.

Results: Moderate and statistically significant associations were found between community mobility and participation variables at baseline and follow-up. However, changes in community mobility were not related to changes in community participation.

Conclusion: Health policymakers and providers should consider community mobility as a factor that can affect community participation in autistic individuals. Plain-Language Summary: Lower levels of community participation among autistic young adults affect health outcomes and overall quality of life. Community mobility is often a barrier to community participation. An understanding of the relationship between community mobility and community participation can lead to occupational therapists tailoring specific interventions and policies that support autistic young adults to engage in important life activities within the community.

Importance: Differences in sensory reactivity are a core feature of autism; however, more remains to be learned about their role in classroom learning.

Objective: To use direct observational measures to investigate whether there is a link between sensory reactivity differences and classroom behaviors of autistic children.

Design: Correlational study.

Setting: Two special educational needs schools.

Participants: Children with a clinical diagnosis of autism, ages 5 to 18 yr (N = 53).

Outcomes and measures: Sensory reactivity differences were assessed with the Sensory Assessment for Neurodevelopmental Differences. Classroom behaviors were measured using the Behavior Assessment for Children-Second Edition Student Observation System.

Results: Total sensory reactivity differences were correlated positively with behaviors that impede learning (r = .31, p < .05) and negatively with behaviors that facilitate learning (r = -.38, p < .05). Hyporeactivity differences were correlated positively with behaviors that impede learning (r = .28, p < .05) and negatively with behaviors that facilitate learning (r = -.31, p < .05). Hyperreactivity and sensory-seeking differences were not significantly correlated with behavior.

Conclusions and relevance: Results suggest a link between sensory reactivity differences and classroom behaviors, highlighting a need for further research using observational measures in special education settings. Plain-Language Summary: Differences in hyporeactivity for children with autism may play a bigger role in classroom behavior and learning than previous literature has suggested. This has implications in occupational therapy practice for how to tailor support for children with hyporeactivity differences.

Importance: Infants who are born preterm often experience difficulty transitioning from full tube to independent oral feeds, which often prolongs their hospital stay. No clinical measures associated with attainment of independent oral feeds are currently available.

Objective: To identify specific nutritive sucking measures associated with time to attainment of independent oral feeds among infants who are born preterm.

Design: An observational cohort pilot study was undertaken.

Setting: A Level 2 to Level 3 neonatal intensive care unit.

Participants: Fourteen infants (7 male, 7 female) born at or less than 34 wk gestation were enrolled.

Outcomes and measures: The monitored suck measures included average suck strength (millimeters of mercury), average sucking burst duration (seconds), average suck count (number of sucks), and average pause duration (seconds). Time to independent oral feeds (days) and baseline characteristics were also monitored. The nutritive sucking measures were recorded once, during the first 5 min of an oral feed, when infants were taking an average of three to four oral feeds per day using a nipple monitoring device.

Results: An inverse relation was found among average suck burst duration (p = .04), gestational age (p = .03), and days to attainment of independent oral feeds.

Conclusions and relevance: Study results suggest that average sucking burst duration, during the first 5 min of an oral feed, is associated with time to attain independent oral feeds. Plain-Language Summary: Sucking burst duration is a simple measure that may be used clinically to identify early on infants who may have trouble transitioning from full tube to independent oral feedings. The results of this study suggest that a suck burst duration in the first 5 min of an oral feeding is inversely associated with the length of time to achieve independent oral feeding. The results highlight the importance of considering an infant's nutritive sucking ability when evaluating their potential to achieve independent oral feedings.

Importance: Understanding the root cause of mental illness stigma is necessary to adopt effective management strategies.

Objective: To establish a stable and effective text-picture integration rating scale to predict public perspectives on mental illness and to examine its reliability and validity.

Design: Descriptive cross-sectional study using internet survey data.

Setting: Online.

Participants: Two hundred volunteers.

Results: The 10-item the Text-Picture Integration Scale for Perspectives on Mental Illness was developed. The authors conducted data analysis using SPSS to evaluate the reliability and criterion-related validity of the Mental Health Literacy Scale (MHLS). The Text-Picture Integration Scale's item-level content validity index ranged from 0.83 to 1.00, and the scale-level content validity index was 0.97. The scale demonstrated acceptable reliability (Cronbach's α = .80). The mean value of individual items ranged from 3.18 to 4.48, and the mean total score was 39.44 (SD = 8.47). The Text-Picture Integration Scale exhibited satisfactory criterion-related validity with the MHLS (r = .76, p < .001).

Conclusions and relevance: Preliminary analyses support that the Text-Picture Integration Scale is a stable and effective rating scale to determine public perspectives on mental illness and is appropriate for evaluating destigmatization efforts. Plain-Language Summary: The study findings support the use of the Text-Picture Integration Scale as a stable and effective rating scale to determine public perspectives on mental illness. The scale is also appropriate for evaluating ways to address the stigmas that people associate with mental illness, which pose challenges for people in recovery. Occupational therapists can leverage their understanding of public perspectives on mental illness when choosing interventions to support the overall well-being of their clients with mental illness.