American Journal of Occupational Therapy最新文献

Importance: Persons living with and beyond cancer (PLWBC) are rarely referred to occupational therapy services despite their functional difficulties. An understanding of the barriers to and facilitators of occupational therapy referrals from the perspective of cancer health care professionals could help minimize referral gaps.

Objective: To explore cancer health care professionals' perspectives on and knowledge of occupational therapy's role in cancer care, identify the barriers, and explore solutions to optimize referrals.

Design: Multiexplanatory qualitative case study.

Setting: Community and hospital cancer clinics in Israel.

Participants: Six in-person focus groups of cancer care Israeli nurses and social workers, totaling 28 participants.

Results: Two main themes were identified: (1) barriers to occupational therapy referrals and (2) partial facilitators of occupational therapy referrals. The four barriers subthemes were (1) gaps in knowledge about symptoms' effects on daily functioning, (2) gaps in knowledge regarding occupational therapy's role in cancer care, (3) bureaucratic and organizational barriers, and (4) unavailability of occupational therapy services. The two facilitators subthemes were (1) collaborations and communication with occupational therapists and (2) awareness of occupational therapy services. Participants suggested practical solutions for improving occupational therapy referrals, interdisciplinary collaboration and communication, and integrating occupational therapy into cancer care.

Conclusions and relevance: Barriers to referrals included gaps in participants' knowledge that link side effects to functional difficulties indicating a need for referral to occupational therapy. Participants' suggestions to bolster referrals can be implemented by occupational therapists to reduce patients' unmet needs and bridge existing gaps in cancer care. Plain-Language Summary: This research helped to identify barriers and facilitators regarding insufficient knowledge about occupational therapy's role in cancer care and adds a better understanding of gaps in referrals to occupational therapy. In addition, cancer health care professionals who participated in the study suggested practical solutions for reducing barriers and maximizing support for referral. With these nuances, occupational therapy practitioners can work with medical cancer care units (i.e., acute care hospitals, medical cancer centers, and community health care clinics) to target the use of strategies that work for their units to ensure that persons living with and beyond cancer receive needed occupational therapy services.

Importance: Driving and community mobility (DCM) is key to supporting independence in teens and young adults (TYA) with autism spectrum disorder (ASD).

Objective: To determine whether an intervention focused on DCM can effectively improve DCM knowledge and skills in TYA.

Design: A pretest-posttest design using the same intervention and outcome measures.

Setting: University research setting.

Participants: Thirty-eight participants with ASD completed the program (M age = 17.76 yr, SD = 3.58). Twenty-six (68%) were male, and 12 (32%) were female.

Intervention: A 5-day intensive intervention using group and individualized strategies, including driving simulation, focused on improving performance skills needed for DCM.

Outcome and measures: Total and category scores of the Performance Analysis of Driving Ability (P-Drive) were analyzed using a repeated-measures analysis of variance measuring time (pretest vs. posttest), gender, and year of intervention. Paired t tests were used to determine the outcomes of the Canadian Occupational Performance Measure (COPM), anxiety measure and perception survey.

Results: Results indicated a significant main effect for time (p < .001) and year (p < .036), but not gender (p < .26), with no significant interaction effects, supporting the fidelity of the intervention. The COPM showed significant changes (p ≤ .001) in both performance and satisfaction, as well as a reduction in anxiety (p = .008).

Conclusions and relevance: Outcomes suggest that the intervention successfully improved DCM knowledge and skills for TYA. This adds new evidence that an occupational therapy intervention specific to TYA with ASD is effective in developing independence in DCM. Plain-Language Summary: Driving is the primary mode of community mobility in North America and other Western countries. Adults with autism spectrum disorder (ASD) who have a means of community mobility have a chance of employment that is 5 times greater than that for those who do not. Driving and community mobility are key to supporting independence among teens and young adults with ASD. However, teens and young adults with ASD have significantly lower rates of getting a driver's license. The results of this study show that occupational therapy practitioners can play a critical role in addressing driving and community mobility. Occupational therapy interventions that are specifically designed for and unique to each teen and young adult with ASD can effectively improve driving and community mobility skills and increase independence.

Importance: Youths with autism spectrum disorder (ASD) have challenges with executive function (EF). However, there are few measures to objectively assess EF, such as time management and prioritization. The Weekly Calendar Planning Activity (WCPA) is a promising performance-based EF measure that has rarely been used with youths with ASD.

Objective: To characterize the performance of youths with ASD on the WCPA and the association of WCPA performance with caregiver-rated EF.

Design: Observational and summary data obtained during a baseline evaluation for a research study.

Setting: Middle school.

Participants: Thirty-nine adolescents with ASD and without an intellectual disability.

Method: Youth were administered the WCPA; caregivers completed EF ratings. Descriptive statistics characterized WCPA performance. Correlations between WCPA scores and age, IQ, and EF ratings were computed.

Results: The majority of youth performed poorly on the WCPA and lacked insight into their poor performance. Many struggled to enter appointments. Appointment accuracy was <30%. The most common errors were location errors. Appointment accuracy and planning time were moderately associated with IQ but not with caregiver-rated EF or age.

Conclusions and relevance: Overall, the WCPA was cognitively demanding for youths with ASD without an intellectual disability. These results have implications for using evidence-based strategies to teach adolescents with ASD how to manage their time and plan and prioritize homework assignments, upcoming tests or quizzes, and extracurricular activities. Plain-Language Summary: Youths with autism spectrum disorder have significant problems with executive function, particularly organization, prioritization, time management, and planning. There are few objective, performance-based measures of executive function, especially those that can be used with autistic youths. To our knowledge, this study is the first to use the Weekly Calendar Planning Activity (WCPA) with autistic adolescents who do not have an intellectual disability. The WCPA captured their deficits related to executive function and could be a useful tool for assessment and treatment planning.

Importance: Parents of nonspeaking children with autism spectrum disorder (ASD) may present with complex challenges associated with communicating with their children.

Objective: To explore the firsthand experiences of parents of children with ASD who use assisted communication (AC) to communicate, which has yet to be explored in the literature.

Design: Semistructured interviews with ten parents of individuals with ASD, age 15 to 36 yr, who use AC to communicate.

Results: Analysis of the data revealed four superordinate themes, each with two subthemes: (1) Relationship (subthemes: Involving the Child, Improved Relationship), (2) Future (subthemes: Hopes and Dreams, Planning), (3) Support (subthemes: Limited Availability of Service Providers, Underestimation), and (4) Understanding (subthemes: Communication, Understanding of the Child). The themes illustrated that using AC modalities improved the parent-child relationship (Relationship) and helped parents understand their child on a deeper level (Understanding). A positive outcome of having a new means of communication with their child was that parents could better plan for a future that reflects their child's innermost hopes and dreams (Future). Parents also reported that the lack of a consensus concerning using AC with nonspeaking children led to decreased support (Support) from professionals and educators, limiting the child's opportunities.

Conclusions and relevance: This study provides phenomenological qualitative evidence that use of AC provides benefits to the parent-child relationship. Plain-Language Summary: This study investigated the lived experience of parents of children with autism spectrum disorder (ASD) and how the use of assisted communication (AC) affected their relationship with their child. Ten parents were interviewed. Four main topics emerged from the analysis of these interviews: (1) improved closeness in relationship, (2) improved ability to plan for the future, (3) wish for improved availability of service providers, and (4) improved understanding of who the child is as a person. Parents play a key role as team members in support of the child's performance in occupations. The results of this study suggest that AC plays an important role in supporting the parent-child relationship; therefore, AC programs should be considered when implementing and planning occupational therapy treatments for individuals who have communication impairments.

Importance: Built environment structures affect a population's occupational participation and health outcomes.

Objective: To examine how occupational opportunities available within walking distance are related to a community's overall health.

Design: Secondary data analysis.

Setting: Community.

Participants: Community-dwelling adults.

Outcomes and measures: Data from the AARP Livability Index and Walk Score® for 78 zip codes were used for path analysis and multiple regression analysis to investigate the relationship between various community factors and the health of the community.

Results: Path analysis for 78 zip codes revealed that the primary determinants of health score were destination diversity and social walk score. Multiple regression analysis revealed that destination diversity (β < .001) and exercise opportunity (β < .001) were significant factors for health score. Multiple regression analysis revealed that destination diversity (β < .001) was a significant factor for social score.

Conclusions and relevance: The results suggest that increased diversity of destinations in a community and opportunities available for social participation within walking distance are associated with better health of residents in the community. Plain-Language Summary: This study highlights how the built environment and opportunities for social participation are associated with a community's overall health. This study found that participation in a variety of group activities contributes to community members' well-being. Understanding how the built environment is related to health outcomes may better equip occupational therapy practitioners to improve the health of an individual, group, or population.

Importance: Understanding burnout among practitioners in skilled nursing facilities (SNFs) and assisted living facilities (ALFs) while considering contextual factors may lead to practices that enhance therapist and patient satisfaction as well as quality of care.

Objective: To examine productivity standards and burnout in the context of setting and role, as reported by therapy practitioners in geriatric settings, and to explore relationships between productivity standards and perceived ethical pressures.

Design: Cross-sectional online survey with descriptive data.

Participants: Practitioners (N = 366) included occupational therapists, physical therapists, speech-language pathologists, and occupational and physical therapy assistants working in SNFs and ALFs in the United States. A survey integrating the Maslach Burnout Inventory: Human Services Survey for Medical Personnel (MBI-HSS) and questions addressing demographics and contextual factors was distributed via social media.

Results: Of 366 practitioners, 20.5% were burned out, exhibiting extreme scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) on the MBI-HSS. Significant relationships between productivity requirements and EE, DP, and PA, after accounting for covariates, were evident. Significant relationships between productivity standards and five of the six ethically questionable behaviors existed. Role affected productivity requirements, specifically between therapists and assistants, whereas setting did not.

Conclusions and relevance: Productivity standards and related pressures are associated with concerning aspects of burnout among practitioners working in geriatric settings. Advocating for change in defining productivity and incorporating positive support in the work environment may assist in reducing burnout and turnover rates and improve patient satisfaction and care. Plain-Language Summary: This research highlights the prevalence of burnout and perceived pressures related to productivity requirements among occupational therapy practitioners working in skilled nursing and assisted living facilities.

Importance: Establishing empirical evidence on the psychometric properties of the Test of Visual-Motor Skills (3rd ed.; TVMS-3) is helpful for guiding its use as an assessment of visual-motor integration (VMI) skills in kindergarten children with developmental coordination disorder (DCD).

Objective: To investigate the test-retest reliability, criterion-related validity, and ecological validity of the TVMS-3 in Taiwanese kindergarten children with DCD.

Design: A nonexperimental, descriptive, correlational design.

Setting: A hospital in Central Taiwan.

Participants: Fifty-seven kindergarten children with DCD were recruited in the study.

Outcomes and measures: Intraclass correlation coefficient, percentage of minimal detectable change, and paired t test (Wilcoxon signed rank test) were used to investigate the test-retest reliability of the TVMS-3. The correlations (Pearson's r) between the TVMS-3 accuracy score and the scores of each of the four domains and the adaptive behavior composite score of the Vineland Adaptive Behavior Scales (3rd ed.; Vineland-3) were calculated, respectively, to examine criterion-related validity and ecological validity.

Results: The accuracy score of the TVMS-3 had excellent test-retest reliability and acceptable random measurement error. Moreover, it showed good criterion-related validity and sufficient ecological validity with the Vineland-3 in Taiwanese kindergarten children with DCD.

Conclusions and relevance: The accuracy score of the TVMS-3 is applicable to Taiwanese kindergarten children with DCD in clinical and research settings. Plain-Language Summary: The accuracy score of the Test of Visual-Motor Skills (3rd ed.; TVMS-3) is a useful assessment tool to detect deficits in visual-motor integration for Taiwanese kindergarten children with developmental coordination disorder. The TVMS-3 has excellent test-retest reliability, good criterion-related validity, and sufficient ecological validity.

Accreditation standards covering occupation have evolved across recent versions of the Accreditation Council for Occupational Therapy Education's (ACOTE®'s) academic B content standards. Because occupational therapy and occupational therapy assistant academic programs are required to provide evidence of compliance with each B content standard, the level of students' learning of occupation warrants attention. The revised Bloom's taxonomy offers a useful framework for examining hierarchical learning action verbs that underpin the degree of complexity of students' learning of occupation within the ACOTE standards. In this column, we provide an analysis of action verbs across ACOTE standards from 2006 to the most recent, 2018 version. The findings reveal a reduction in accreditation requirement trends covering occupation in both lower and higher order cognitive skill levels as described in the revised Bloom's taxonomy. We advocate for increased curricular content centered on the foundations of occupation so that students and future practitioners can increasingly apply, analyze, evaluate, and creatively use occupation in the classroom and in practice.

Importance: The Supporting and Enhancing NICU Sensory Experiences (SENSE) program is an evidence-based intervention that promotes daily, positive sensory exposures for infants in the neonatal intensive care unit (NICU). Understanding program implementation across sites may aid in optimizing strategies for uptake of the program and subsequently improve outcomes for infants and families.

Objective: To investigate health care professionals' perceptions of implementing the SENSE program.

Design: The SENSE Program Implementation Survey was developed using Proctor et al.'s model and the BARRIERS scale to probe organizational practices across sites worldwide.

Setting: Survey distributed to 211 hospitals with a SENSE program license obtained before March 2020.

Participants: One hundred fourteen NICU personnel (response rate = 54%).

Outcomes and measures: The survey sought to understand barriers and facilitators, adaptations during implementation, and associated costs.

Results: Of the 53% (n = 57 of 107) of respondents who had implemented the SENSE program, many (n = 14; 31%) experienced quick timing (<1 mo) to use, including spread to nearly all infants in their NICU within 6 mo (n = 18; 35%). Most reported the program was used to educate families ≤3 days of birth (n = 20/59; 34%). Most of the sensory interventions in the program were performed by parents (n = 38; 67%) and therapists (n = 44; 77%). Barriers and facilitators at the organizational and individual levels were identified. No additional staff were hired to implement the program.

Conclusions and relevance: Given perceived successes and challenges, strategic enhancement of implementation can inform future administrations of the SENSE program. Plain-Language Summary: This study provides occupational therapists who are interested in implementing the SENSE program (Supporting and Enhancing NICU Sensory Experiences) with an understanding of common barriers, facilitators, costs, and adaptations, which can be used to advocate for program implementation in NICUs to improve outcomes for preterm infants worldwide.