American Journal of Occupational Therapy最新文献

Importance: School-based occupational therapists are well positioned to provide oral feeding management, yet understanding of how they can effectively address oral feeding goals in school systems is limited.

Objective: To evaluate the current role of occupational therapy in pediatric oral feeding management in school-based settings.

Evidence review: The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews was used as a guide. Six databases (CINAHL, Medline, PsycINFO, Embase, Web of Science, and Google Scholar) and four search engines (Bing, Google, Yahoo, and Ask.com) were searched with the keywords feeding, school, and occupational therapist. Studies with the following criteria were included: written in English, services provided in a school setting, children from junior kindergarten to Grade 12, and the management of oral feeding by occupational therapists in schools.

Findings: An initial 189 articles were generated, and 10 articles met the eligibility criteria after elimination of duplicate studies and title and abstract screening. Four areas emerged regarding the role of occupational therapy in feeding in schools: (1) using a multidisciplinary collaborative approach to support students with feeding needs; (2) offering assessment strategies that range from informal to standardized methods; (3) implementing various intervention techniques, but evidence is limited, and (4) formalizing policies to include feeding goals in students' individual education plans, although the process for doing so remains unclear.

Conclusions and relevance: The field of occupational therapy needs more evidence-based practice, more training in oral feeding management, and updated policies for oral feeding management in schools. Plain-Language Summary: Occupational therapists are well positioned to support the feeding needs of children in schools. This scoping review identifies four key roles for occupational therapists: collaborating with multidisciplinary teams to address feeding issues, conducting assessments from informal to standardized methods, providing a range of intervention strategies, and advocating for formal policies that incorporate feeding goals into students' individual education plans to better manage oral feeding challenges in the school setting.

Importance: The role of occupational therapy in the rehabilitation of adults with persistent postconcussion symptoms (PPCS) following mild traumatic brain injury is an emerging practice area. Research that contributes to growing knowledge and understanding of the profession's role may increase the recognition and visibility of occupational therapy in concussion rehabilitation programs.

Objective: To identify and categorize (using World Health Organization International Classification of Functioning, Disability and Health [WHO ICF] One-Level Classification domains) existing literature that describes occupational therapy practice (including assessments and interventions) in the rehabilitation of adults with PPCS.

Data sources: Five scientific databases (MEDLINE, Embase, Emcare, PsycINFO, and CINAHL Complete) and gray literature were searched.

Study selection and data collection: Eligibility criteria included publications between 2013 and 2023, written in English, and within the peer-reviewed literature or on specified web domains (.gov, .edu, or .org).

Findings: Nineteen publications from 16 sources met eligibility criteria, consisting of quantitative studies (n = 6); case studies, series, or reports (n = 3); qualitative studies (n = 2); systematic or scoping literature reviews (n = 2); and gray literature sources (n = 3). The United States was the origin for many sources (n = 10). Assessments and interventions reported were heterogenous, mapping across 27 of the 30 WHO ICF One-Level Classifications.

Conclusions and relevance: Evidence to inform occupational therapy practice in adult PPCS rehabilitation is limited; however, some useful information about the assessments and interventions used by occupational therapists was found. At a time when considerable advancements in concussion rehabilitation are occurring, further research on evidence-informed occupational therapy practice is required. Plain-Language Summary: This study reviewed existing evidence about the role of occupational therapy in the rehabilitation of adults with persistent postconcussion symptoms (PPCS). It identifies and methodically documents a range of occupational therapy assessments and interventions described in the literature that may be used by occupational therapists within concussion rehabilitation programs or research. The study also categorizes these by using an internationally recognized taxonomy, the World Health Organization's International Classification of Functioning, Disability and Health. The review offers a novel synthesis of published evidence to guide occupational therapy practice and inform resource allocation in concussion rehabilitation. It also highlights the need for further research about the role of occupational therapy-including both high-quality evidence of current approaches and identification of future practice opport

Importance: Neurogenic bladder can negatively affect quality of life for children with incomplete spinal cord injury. Occupational therapy practitioners are uniquely able to provide individualized care to address this, which may include external pelvic floor biofeedback.

Objective: To describe the implementation of external pelvic floor biofeedback for bladder management within the context of toileting for children with neurogenic bladder dysfunction following incomplete spinal cord injury.

Design: Retrospective case series.

Setting: Inpatient rehabilitation unit within a pediatric hospital.

Participants: Three children with incomplete spinal cord injury were enrolled.

Intervention: External pelvic floor biofeedback.

Outcomes and measures: The study used the Functional Independence Measure for Children (WeeFIM®), Activity Measure for Post-Acute Care (AM-PAC) Daily Activities Short Form, Pediatric Spinal Cord Injury Activity Measures (PEDI-SCI AM) Short Forms, and voiding characteristics.

Results: No adverse events occurred. Following biofeedback, all children improved their AM-PAC toileting scores, and PEDI-SCI AM scores improved for 2 of 3 children, whereas daily catheterization requirements decreased for all children. The WeeFIM did not detect changes in bladder management for 2 of 3 children.

Conclusions and relevance: This case report described how occupational therapy practitioners used external pelvic floor biofeedback as an adjunct conservative treatment strategy when providing care for pediatric children with recent incomplete spinal cord injury. Plain-Language Summary: Neurogenic bladder dysfunction following incomplete spinal cord injury can negatively affect a child's quality of life and social participation. Occupational therapy practitioners are uniquely able to address bladder management within the context of toileting for children with acquired incomplete spinal cord injury. A multimodal approach, which includes biofeedback, may improve the child's level of independence with toileting.

Importance: Single-case designs (SCDs) offer a powerful research methodology for demonstrating the effectiveness of occupational therapy interventions for diverse clients with individualized needs. However, the current state of the use of SCDs in occupational therapy remains unclear.

Objective: To summarize the current state of and challenges associated with the use of SCDs in occupational therapy.

Data sources: Articles were retrieved from the following databases: PubMed, Web of Science, PsycINFO, OTDBASE, and CINAHL. Related articles were manually searched to identify relevant studies, with the publication year restricted to 1990 to 2023.

Study selection and data collection: This scoping review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The search terms used were occupational therapy, single-case design, and synonyms for single-case design. The search was restricted to journals specifically dedicated to occupational therapy.

Findings: Eighty-eight studies met the inclusion criteria for this review. Existing research has focused on the practice areas of children and youth and physical disabilities or rehabilitation. Moreover, AB designs, ABA designs, and visual analysis that do not meet the What Works Clearinghouse standards are frequently used as research methods.

Conclusions and relevance: Although SCDs can be highly useful in demonstrating the effectiveness of occupational therapy interventions for diverse clients with individualized needs, considering the quality of SCDs when designing studies is crucial. Plain-Language Summary: This scoping review delved into the current landscape and challenges of single-case designs (SCDs) in occupational therapy. The findings revealed the pervasive adoption of low-quality designs and the predominant use of visual analysis methods in this field. In light of these findings, it is imperative for future research and development efforts to embrace established guidelines, paving the way for enhanced methodological rigor and robust outcomes.

Importance: Stroke rehabilitation in clinic- and home-based settings may yield differential effects on motor and functional outcomes.

Objective: To investigate the effects of mirror therapy preceding augmented-reality therapy in the clinic and home setting.

Design: Single-blinded, randomized crossover study.

Setting: Rehabilitation clinics and home environment of participants.

Participants: Thirty-one stroke survivors.

Intervention: Participants were randomized to receive clinic-based practice first or home-based practice first. The intervention involved mirror therapy-primed augmented-reality practice. Participants received nine treatment sessions, with a 3-wk washout period between two phases.

Outcomes and measures: Outcome measures included the Fugl-Meyer Assessment Scale of Upper Extremity (FMA-UE), Berg Balance Scale (BBS), Chedoke Arm and Hand Activity Inventory, Motor Activity Log (MAL), and Stroke Impact Scale (SIS).

Results: Clinic-based practice significantly improved the FMA-UE (p = .04), BBS (p = .01), and SIS Mobility domain scores (p = .05). Home-based practice showed a trend for better performance on the MAL. Clinic-based practice revealed retention of treatment gains at the 3-mo follow-up assessment on the FMA-UE (p = .01) and the Activities of Daily Living-Instrumental Activities of Daily Living (p = .01), Mobility (p = .02), and Hand Function (p = .03) domains of the SIS.

Conclusions and relevance: Clinic-based practice improved motor and balance deficits, whereas home-based practice may enhance functional arm use. Practice setting is relevant for consideration in stroke rehabilitation. Plain-Language Summary: Research supports the benefits of using augmented reality in stroke rehabilitation. Stroke rehabilitation that includes mirror therapy has also shown promising benefits. This study investigated the effects of using mirror therapy before augmented-reality therapy to improve motor and balance after a stroke. Stroke survivors participated in sessions in either a clinic- or a home-based setting. The results showed that the clinic-based sessions led to more improvements in motor and balance, whereas the home-based sessions improved patients' use of the affected arm in real-life situations. The findings suggest the need to take into consideration the occupational therapy practice setting as part of stroke rehabilitation. Clinic- and home-based practice may complement each other to optimize the effects of stroke rehabilitation.

Importance: Current barriers exist that affect occupational therapy students' and practitioners' ability to understand statistical methods and translate knowledge into their clinical work.

Objective: To determine which statistical methods are most commonly used in the occupational therapy literature and, consequently, which methods are most critical to include in occupational therapy curricula to equip students to be better consumers of occupational therapy literature and implement evidence in practice.

Design: A thorough analysis of 1,223 journal articles across 13 core occupational therapy journals. The most common statistical methods from the core journals were recorded.

Outcomes and measures: The frequencies and percentages of each statistical method that were reported were calculated, and the top 25 statistical methods were ranked.

Results: The analysis revealed that the top statistical methods included descriptive statistics, t tests, confidence intervals, χ2, effect size, analysis of variance, parametric correlations, Cronbach's α, post hoc analysis and pairwise comparisons, and thematic analysis and coding.

Conclusions and relevance: The study determined the top 25 statistical methods used in the core occupational therapy literature. Occupational therapy educational programs can use this study as guidance for the inclusion of statistical content in their respective programs. Plain-Language Summary: This study was conducted to determine which statistical methods are most commonly used in occupational therapy research. We reviewed 13 key occupational therapy journals and identified the 25 most frequently used methods. These results can help improve how statistics is taught in occupational therapy programs.

Concussions are prevalent in youth and often contribute to occupational challenges related to postconcussion syndrome within the educational setting. Despite the advancements that have been made in the occupational therapy management of concussion, school-based occupational therapy practitioners are seeking clarity in service delivery because there is no clear framework that guides service provision for postconcussed youth within the educational setting. In this column, we emphasize the role of school-based occupational therapists as an existing source of support within the school structure, describe school-based occupational therapy as a viable service for postconcussed youth, and highlight a feasible framework that can be applied to service delivery within the educational setting to support the recovery of postconcussed youth.