American Journal of Occupational Therapy最新文献

Importance: Autistic youth who graduate with a high school diploma may experience challenges in acquiring functional skills for everyday independence. Few studies have focused on how their functional and self-management skills change during the transition to adulthood.

Objective: To examine cross-sectional differences and longitudinal changes in the functional and self-management skills of transition-age autistic youth.

Design: Exploratory longitudinal study (18-mo follow-up).

Setting: Community.

Participants: Autistic high school students who graduated with a high school diploma and their parents (N = 50).

Outcomes and measures: Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (ASD).

Results: Older youth (ages 18-20 yr) had significantly lower normative Social/Cognitive and Responsibility domain scores (i.e., self-management) than youth ages 14-17 yr. Approximately 2 yr later, youth in both age groups significantly improved in scaled scores on the Daily Activities and Responsibility domains.

Conclusions and relevance: Autistic youth's functional and self-management skills fell below those of nonautistic peers; however, these skills do change over time and are therefore appropriate targets for intervention. Plain-Language Summary: The findings of this study highlight the importance of focusing on the functional and self-management skills of autistic youth as part of their transition to adulthood. Occupational therapists can play a valuable role in helping autistic youth to achieve independence as adults by assessing their functional needs and strengths and by providing client-centered interventions.

Importance: Occupational therapy practitioners use standardized assessments to guide their clinical decision-making, but it is unclear how well performance on standardized assessments translates to performance at home.

Objective: To understand the concurrent and predictive validity of patient-reported outcomes and performance-based assessments for monitoring performance at home within the context of medication management and adherence.

Design: Exploratory study.

Setting: Participants completed standardized assessments in a lab or at home, which were followed by home-based electronic monitoring of medication adherence.

Participants: Sixty community-dwelling adults with hypertension or stroke who independently took antihypertensive medications.

Outcomes and measures: Participants completed the Hill-Bone Medication Adherence Scale, the Hill-Bone Medication Adherence Reasons Scale, the Performance Assessment of Self-Care Skills Medication Management subtask, and the Executive Function Performance Test-Enhanced Medication Management subtest. Then, they used an electronic pill cap to monitor medication adherence at home for 1 month.

Results: Patient-reported outcomes and performance-based assessments in the context of medication management and adherence demonstrated poor concurrent and predictive validity to medication adherence at home.

Conclusions and relevance: There is a gap between what people think they will do, what they can do on a standardized assessment, and what they actually do at home. Future research is needed to strengthen concurrent and predictive validity to clinically meaningful outcomes. Plain-Language Summary: Occupational therapy practitioners should use caution when using standardized assessments to try to predict client performance at home. They should also continue to use a battery of assessments, clinical reasoning, and client preferences to guide their decision-making for monitoring performance at home within the context of medication management and adherence.

Importance: Stroke survivors experience changes in participation level, satisfaction with participation, and participation balance, making it necessary to have a validated tool for their assessment.

Objective: To evaluate the psychometric properties of the Spanish version of the Satisfaction With Daily Occupations and Occupational Balance (SDO-OB) in stroke survivors.

Design: Psychometric study.

Setting: National multicenter study (rehabilitation centers, and hospitals).

Participants: One hundred forty stroke survivors with and without a primary caregiver.

Outcomes and measures: Participants completed the SDO-OB, the five-level version of the EQ-5D (EQ-5D-5L), and the Activity Card Sort (ACS). Internal consistency, convergent validity, known-groups validity, and floor and ceiling effects were assessed. Intraobserver reliability was assessed 1 wk apart.

Results: The internal consistency was acceptable; Cronbach's α = .80, 95% confidence interval (CI) [0.75, 0.85]. A moderate correlation was found between the SDO-OB summed participation level and summed participation satisfaction (ρ = .53). Both SDO-OB summed scores correlated with ACS scores (0.25 < ρ < .61). However, only summed participation satisfaction scores correlated with the emotional component of the EQ-5D-5L (ρ = .32). The SDO-OB discriminated between groups with and without a caregiver (p = .001) and had no floor or ceiling effects (<7%). Good intraclass correlation coefficients (ICCs) were obtained for summed participation level (ICC = .91; 95% CI [.85, .94]) and summed participation satisfaction (ICC = .86; 95% CI [.78, .92]). Standard error of measurement and minimum detectable change were 0.7 and 1.9 points, respectively, for summed participation level and 4.5 and 12.4, respectively, for summed participation satisfaction.

Conclusions: The Spanish version of the SDO-OB presented good psychometric properties, making it a suitable instrument to address participation level, participation satisfaction, and participation balance in stroke survivors. Plain-Language Summary: After a stroke, survivors experience changes in their participation in daily activities and how satisfied they are with them. This study examined whether a tool called Satisfaction With Daily Occupations and Occupational Balance (SDO-OB) could provide reliable information about this. We looked at 140 stroke survivors from different places in Spain to see whether they had someone caring for them, how healthy they were, and how their participation in daily activities changed after stroke. We found that the SDO-OB is helpful for understanding a stroke survivor's situation and can identify areas needing intervention and track changes caused by intervention plans.

Importance: Assuming the care of a family member with a disability or chronic illness constitutes a health risk factor for caregivers, who frequently overlook their own self-care.

Objective: To analyze the self-care activities (SCAs) among caregivers of a family member with a disability or chronic illness and assess the impact on their satisfaction and quality of life (QoL).

Design: Descriptive, cross-sectional, analytic study.

Setting: Community.

Participants: Five hundred caregivers of family members with a disability or chronic illness in the city of Zaragoza, Spain.

Outcomes and measures: The family caregivers' occupational performance and satisfaction were assessed with the Canadian Occupational Performance Measure, and their QoL was assessed with the World Health Organization-Quality of Life.

Results: In total, 32.8% of family caregivers had difficulty in all activities related to self-care, 46.6% had difficulty sleeping and resting, 31.6% had difficulty receiving health-related treatments, and 31.2% had difficulty with physical exercise. Women and younger family caregivers showed greater impairment in self-care. Occupational performance, satisfaction, and QoL worsened as the number of affected activities increased.

Conclusions and relevance: Caring for a family member with a disability or chronic illness has a negative impact on the SCAs of caregivers, especially among female caregivers and those of younger age. Caregiving is also associated with lower occupational performance, satisfaction, and QoL. Plain-Language Summary: Caring for a family member with a disability or chronic illness can become a health risk for caregivers, who frequently ignore their own self-care. The study results found that women and younger family caregivers showed a greater decline in self-care. This study provides information to help occupational therapists to work with family caregivers to prevent a decline in their self-care and improve their quality of life.

Importance: Coloring is popular with preschool children and reveals their developmental state. However, interpreting coloring performances is challenging because descriptive and subjective evaluations are commonly used with large variations.

Objective: To develop a scoring method to objectively quantify children's coloring skills.

Design: Colored blank train templates were analyzed using four indicators (entropy, complexity, coloring outside the lines, and unexpected blank areas) to form a summed score.

Setting: Kindergarten in a urban city (Tainan, Taiwan).

Participants: Two hundred thirty-nine typically developing children ages 3 to 6 yr.

Outcome and measures: A newly developed method to assess coloring skill on the basis of a colored picture of a train.

Results: The summed score exhibited good internal consistency (Cronbach's α = .80), discriminative validity (p = .04), convergent validity (rs = .66 and .59 with age and visual-motor integration), and acceptable factorial validity (comparative fit index = .99, standardized root-mean-square residual = .04, and root-mean-square error of approximation = .13). Moreover, three coloring patterns (mature, transitional, and immature) were identified.

Conclusions and relevance: The new method provides objective, reliable, and valid scores representing coloring skills in typically developing children. In addition, the coloring patterns can be recognized. This method can be used to facilitate comparisons of children's coloring skills with peers and provide valuable insight into children's development. Plain-Language Summary: This study proposes a new method to objectively quantify children's coloring skills with sound reliability and validity in typically developing children. The method can be used to evaluate children's coloring skills and patterns to shed light on their developmental stages.

Importance: Environmental modifications are targets for occupational therapy intervention because they support activities of daily living, self-efficacy, personal control, independence, and community living for people with intellectual and developmental disabilities (IDDs).

Objective: To examine how environmental modifications were provided to people with IDDs through Medicaid home- and community-based services (HCBS) waivers across the United States in fiscal year (FY) 2021.

Design: Using a mixed-methods policy analysis, we examined FY 2021 Medicaid HCBS 1915(c) waivers from across the United States to examine whether, and how, states provided environmental modifications to people with IDDs.

Results: In FY 2021, 35 states projected spending $68.8 million on environmental modifications for 12,671 people with IDDs. The purpose of environmental modifications was most often to promote the health, welfare, and safety of people with IDDs (82.68%), and to promote their independence (69.29%). The most common examples of environmental modifications included ramps and/or lifts (70.08%), widening doorways and/or hallways (61.42%), bathroom modifications (58.27%), specialized electrical and/or plumbing for medical equipment (54.33%), and grab bars and/or handrails (53.54%).

Conclusions and relevance: HCBS waiver data on environmental modifications for people with IDDs enhances an understanding of this funding source and provides a foundation of advocacy for occupational therapy practitioners to support people with IDDs with living, as well as aging, in the community rather than in institutions. An expansion of environmental modifications in HCBS for people with IDDs aligns with the aim of Medicaid HCBS waivers to promote community integration, self-determination, and independence, which are all benefits of environmental modifications. Plain-Language Summary: This study can help occupational therapy practitioners determine what funding sources are available in their state to help their clients with intellectual and developmental disabilities access environmental modifications. The findings can also help guide advocacy and lobbying efforts to expand access to environmental modifications.

Importance: Complex telehealth interventions can facilitate remote occupational therapy services and improve access for people living with chronic neurological conditions. Understanding the factors that influence the uptake of these technologies is important.

Objective: To explore the fit between electromyography (EMG) biofeedback and telerehabilitation for stroke survivors, optimize EMG biofeedback interventions, and, more broadly, support other efforts to develop complex telerehabilitation interventions.

Design: Pre-implementation mixed-methods analysis of usability and acceptability data collected during a pilot and feasibility study.

Setting: Community.

Participants: Adult stroke survivors with hemiparesis (N = 11; M age = 54 yr).

Intervention: Game-based EMG biofeedback system for arm sensorimotor rehabilitation, delivered via telehealth.

Outcomes and measures: Post-Study System Usability Questionnaire, an extended Unified Theory of Acceptance and Use of Technology model questionnaire, and semistructured interview. We coded the interview data using questionnaire constructs.

Results: Participants used an EMG biofeedback intervention at home. Quantitative measures show high levels of perceived usability and acceptability, supported by qualitative findings describing specific facilitators and barriers.

Conclusions and relevance: Pre-implementation studies can improve the design and relevance of complex telehealth interventions. One major conclusion from this study is the influence of therapy providers on acceptability and usability of complex telehealth interventions. Plain-Language Summary: This study contributes to an emerging body of literature that examines the use of complex telehealth interventions with survivors of neurological injury. The findings highlight the value and support the development and use of complex telehealth interventions, which have the potential to improve remote access to occupational therapy for clients living with chronic neurological conditions. Complex telehealth interventions can open doors for survivors of neurological injury who face barriers to accessing occupational therapy and would benefit from technology-enabled therapy at home.

Importance: Handedness and motor asymmetry are important features of occupational performance. With an increased understanding of the basic neural mechanisms surrounding handedness, clinicians will be better able to implement targeted, evidence-based neurorehabilitation interventions to promote functional independence.

Objective: To review the basic neural mechanisms behind handedness and their implications for central and peripheral nervous system injury.

Data sources: Relevant published literature obtained via MEDLINE.

Findings: Handedness, along with performance asymmetries observed between the dominant and nondominant hands, may be due to hemispheric specializations for motor control. These specializations contribute to predictable motor control deficits that are dependent on which hemisphere or limb has been affected. Clinical practice recommendations for occupational therapists and other rehabilitation specialists are presented.

Conclusions and relevance: It is vital that occupational therapists and other rehabilitation specialists consider handedness and hemispheric lateralization during evaluation and treatment. With an increased understanding of the basic neural mechanisms surrounding handedness, clinicians will be better able to implement targeted, evidence-based neurorehabilitation interventions to promote functional independence. Plain-Language Summary: The goal of this narrative review is to increase clinicians' understanding of the basic neural mechanisms related to handedness (the tendency to select one hand over the other for specific tasks) and their implications for central and peripheral nervous system injury and rehabilitation. An enhanced understanding of these mechanisms may allow clinicians to better tailor neurorehabilitation interventions to address motor deficits and promote functional independence.

Importance: Current interventions are limited in improving use of the more-affected upper limb in real-world daily occupations and functional independence poststroke. A comprehensive understanding of the factors influencing real-world upper limb use is required to develop interventions to improve functional independence poststroke.

Objective: To systematically review the factors that influence real-world use of the more-affected upper limb poststroke.

Data sources: We searched MEDLINE, Embase, PsycINFO, and the Physiotherapy Evidence Database for English-language articles from 2012 to 2023.

Study selection and data collection: Of 774 studies, we included 33 studies that had participants at least age 18 yr who exhibited upper limb impairments poststroke, objectively measured real-world upper limb use using a movement sensor, and measured factors affecting upper limb use. Two reviewers independently screened the abstracts.

Findings: The results were categorized by International Classification of Functioning, Disability and Health domains. Prominent factors were upper limb impairment; motor ability; functional independence; task type; hand dominance; stroke-related factors, including time since stroke; and perception of use of the more-affected upper limb.

Conclusions and relevance: Existing interventions primarily focus on upper limb impairments and motor ability. Our findings suggest that interventions should also incorporate other factors: task type (unilateral vs. bilateral), hand dominance, self-efficacy, and perception of more-affected limb use as active ingredients in improving real-world use of the more-affected upper limb poststroke. We also provide recommendations to use behavioral activation theory in designing an occupation-focused intervention to augment self-efficacy and confidence in use of the more-affected upper limb in daily occupations. Plain-Language Summary: In order to develop interventions to improve functional independence poststroke, occupational therapy practitioners must have a comprehensive understanding of the factors that influence real-world more-affected upper limb use. The study findings provide a set of distinct factors that practitioners can target separately or in combination to improve real-world use of the more-affected upper limb poststroke.