American Journal of Occupational Therapy最新文献

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.

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.

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.

Importance: The Electronic Activity Card Sort (ACS3) is an online adaptation of the in-person Activity Card Sort (ACS). It is important to validate the ACS3 within clinical populations.

Objective: To assess the discriminant validity of the ACS3 between persons with multiple sclerosis (MS) and those with traumatic brain injury (TBI).

Design: Cross-sectional.

Setting: Telehealth.

Participants: Community-dwelling adults with either MS (n = 11) or TBI (n = 11).

Outcomes and measures: The ACS3 was administered via virtual interview. Analyses (t tests) were conducted to compare persons with TBI and those with MS on the ACS3 and compare the preinjury or preillness and current activity scores for each group. Correlations between demographic characteristics and ACS3 scores were computed, using Pearson correlations for continuous variables and Spearman correlations for categorical data.

Results: All participants (n = 22) demonstrated significant reductions from before to after injury/illness for each domain and total ACS3 scores. Furthermore, the MS group retained fewer activities than the TBI group in the ACS3 total score.

Conclusions and relevance: The results provide preliminary evidence for the discriminant validity of the ACS3's capacity to distinguish between adults with MS and those with TBI. The ACS3 may be a clinically useful tool for evaluating life participation in persons with chronic neurological conditions. Plain-Language Summary: Involvement in life situations, or participation, is an essential outcome in rehabilitation, and is associated with higher quality of life, decreased depression, and better overall well-being. Changes in health can reduce participation in meaningful life activities, which can negatively affect independence and life satisfaction. Meaningful patient engagement emphasizes and supports patient participation as an essential outcome in rehabilitation that includes occupational therapy. The Electronic Activity Card Sort (ACS3) is an online adaptation of the in-person Activity Card Sort (ACS). The ACS3 is a virtual option for measuring participation in adults with chronic neurological conditions. This study explored using ACS3 to identify changes in participation levels between adults with multiple sclerosis (MS) and those with traumatic brain injury (TBI). The study factored in both current and previous participation levels. Using ACS3, occupational therapists were able to differentiate participation patterns among those with MS and those with TBI. In a clinical setting, ACS3 can be used to guide personalized rehabilitation strategies for two distinct neurological conditions, thereby improving patient outcomes.

Importance: Veterans with occupational performance (e.g., activities of daily living [ADL]) limitations who are receiving inpatient psychiatric care may benefit from outpatient occupational therapy upon discharge, but access disparities have not been investigated.

Objective: To investigate whether ADL limitations, an indicator of need, are associated with outpatient occupational therapy utilization after inpatient psychiatric hospitalization in the Veterans Health Administration (VHA) and whether this relationship differs by facility characteristics.

Design: Secondary analysis of VHA medical record data. Modified Poisson regression was used to model outpatient occupational therapy utilization (yes or no) as a function of ADL limitations, facility characteristics, and sociodemographic and clinical characteristics. Interactions were used to estimate whether the relationship between ADL limitations and outpatient occupational therapy utilization differs across facility characteristics.

Setting: VHA outpatient setting.

Participants: Veterans who received VHA inpatient psychiatric care from 2015 to 2020 and lived ≥90 days after discharge (N = 117,679).

Intervention: None.

Outcomes and measures: Outpatient occupational therapy utilization ≤90 days of inpatient psychiatric discharge.

Results: Only 13% of Veterans received outpatient occupational therapy services after discharge, and ADL limitations were not associated with receipt of occupational therapy. Veterans receiving care in facilities of lower complexity and those with greater care quality were more likely to receive occupational therapy. Black and Hispanic Veterans were less likely to receive occupational therapy.

Conclusions and relevance: Our findings suggest potentially unmet need for outpatient occupational therapy among Veterans discharged from VHA inpatient psychiatric care, laying the foundation for efforts aimed at promoting equitable access. Plain-Language Summary: This is the first study to examine potential disparities in access to outpatient occupational therapy services among Veterans recently discharged from Veterans Health Administration inpatient psychiatric care. The findings suggest a potentially unmet need for these beneficial services in this population. This study lays the foundation for scientific, clinical, and policy efforts aimed at promoting equitable access to outpatient occupational therapy services among Veterans in need, ensuring successful occupational performance and overall well-being among all members of this high-risk population.

Importance: Examining an older adult cohort to determine how different types of visual impairment affect independence in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) is an important first step to better understand how to support older adults with specific types of visual dysfunction and enhance their functional abilities.

Objective: To examine the relationship between distance visual acuity, near visual acuity, and contrast sensitivity and individual ADLs (dressing, toileting, bathing, eating) and IADLs (laundry, shopping, making hot meals, money management, self-management of medications) among community-dwelling older adults.

Design: A retrospective, cross-sectional design was used to analyze the relationship between visual function and independence in ADLs and IADLs.

Participants: We retrieved data for 4,947 people included in the National Health and Aging Trends Study in 2022.

Outcomes and measures: We used a series of multivariable logistic regression analyses and estimated the relationship between visual function and independence in specific ADLs and IADLs.

Results: Near visual acuity and contrast sensitivity were statistically associated with specific ADLs and IADLs. Distance visual acuity was significantly associated with specific IADLs but was not significantly associated with any ADLs.

Conclusions and relevance: Certain visual impairments were associated with specific ADLs and IADLs and therefore should be considered in the care of community-dwelling older adults. Plain-Language Summary: Normal aging can cause vision to decline. Visual impairment and blindness are expected to nearly double by 2050. Vision is a key component of independence for specific activities of daily living (ADLs; such as dressing, toileting, bathing, eating) and instrumental activities of daily living (IADLs; such as laundry, shopping, making hot meals, money management, self-management of medications). This study examined the relationship between visual impairments and individual ADLs and IADLs among community-dwelling older adults. The study found that certain visual impairments were associated with specific ADLs and IADLs and therefore should be considered in the care of community-dwelling older adults. This study also provides evidence that specific visual impairments are closely linked to older adults' ability to perform ADLs and IADLs. The findings confirm the importance of addressing visual function in occupational therapy practice to support the independence of community-dwelling older adults.

Importance: Comprehensive and validated assessments for use in clinical and research settings are needed to identify and address the complexities of feeding challenges for autistic children.

Objective: To establish the convergent validity of the Feeding and Eating in AutiSm Together (FEAST) questionnaire compared with two other validated parent-reported feeding assessments with similar constructs, the Behavior and Mealtime Behavior Index of Children (BAMBIC) and Screening Tool of Feeding Problems applied to Children (STEP-CHILD).

Method: Data from the Survey for Characterization of Feeding Challenges in Autistic Children-US (N = 349) were used to determine the convergence between the FEAST, BAMBIC, and STEP-CHILD using Pearson's correlation tests.

Design: Cross-sectional validation study.

Results: The FEAST total score and FEAST Behavior subscale were found to have moderate, positive correlations with comparison measures, supporting the convergent validity of the FEAST. Relationships between the remaining FEAST subscales and BAMBIC and STEP-CHILD subscales were primarily weak or nonsignificant, demonstrating that their respective scores are capturing distinct factors related to feeding. One expected exception was a moderate positive correlation between the FEAST Oral Motor subscale and the STEP-CHILD Chewing Problems subscale.

Conclusions and relevance: The FEAST demonstrates adequate convergent validity the BAMBIC and STEP-CHILD. The weak correlations of the FEAST Gastrointestinal Health, Sensory Processing, and Oral Motor Skills subscales provide evidence that FEAST may capture additional information about the factors that influence feeding challenges. The FEAST provides clinicians and researchers with a new comprehensive assessment of feeding challenges for autistic children.  Plain Language Summary: This study tested how well the Feeding and Eating in AutiSm Together (FEAST) questionnaire, used to assess feeding and eating challenges among autistic children, matches up with two established feeding assessments, the Behavior and Mealtime Behavior Index of Children (BAMBIC) and the Screening Tool of Feeding Problems applied to Children (STEP-CHILD). Researchers used data from a survey about feeding challenges in autistic kids to compare these feeding assessment tools. They found that the FEAST questionnaire's total score and Behavior subscale scores showed good agreement with the other assessments. Other FEAST subscales (Sensory, Oral-Motor, and Gastrointestinal) were not as related to the BAMBIC or STEP-CHILD scores. This suggests that although FEAST aligns well with general feeding and behavioral concerns, it may offer extra insights into more specific feeding issues. Overall, the FEAST questionnaire could give a more detailed view of feeding challenges among autistic children compared with the other tools. Pos