American Journal of Occupational Therapy最新文献

Importance: Widely used for assessing levels of disability, the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) provides informative profiles for six life perspectives. However, its utility is constrained by its lengthy assessment time, decreasing respondents' willingness to complete it.

Objective: To address the utility challenge by developing a computerized adaptive testing system of the WHODAS 2.0 (CAT-WHODAS 2.0) for people with dementia.

Design: Fit indices were analyzed for a multidimensional Rasch model. The consistency of item difficulties was examined for the score comparability for examinees across sexes. The best set of stopping rules was determined using simulations to achieve high reliability and efficiency simultaneously.

Setting: Community.

Participants: The responses of 3,124 people were obtained from a nationwide database for disability certification, assessed through interviews.

Results: Twenty-seven items exhibited satisfactory model fits (infit and outfit mean squares = .58-1.35), and no items demonstrated differential item functioning by sex (difference values = -0.07 to 0.04). With the best set of rules, the CAT-WHODQAS 2.0 required approximately nine items to provide high Rasch person reliabilities in the six domains. These reliabilities were similar to those of the item bank (.90-.91 versus .93-.96). The concurrent validity was excellent: Pearson's rs = .90-.94 with the raw domain scores and .96-.99 with item bank.

Conclusions and relevance: The CAT-WHODAS 2.0 can provide efficient, reliable, valid, and sex-unbiased assessments of disability for people with dementia. It may serve as an alternative for clinicians and researchers to optimize the efficiency of data collection. Plain-Language Summary: This article presents the computed adaptive testing of the World Health Organization Disability Assessment Schedule 2.0 (CAT-WHODAS 2.0) as an efficient solution to provide reliable, valid, and sex-unbiased assessments of disability among people with dementia. The CAT-WHODAS 2.0 is a promising alternative for clinicians because it can efficiently assess a person's level of disability with extremely high reliabilities in the six domains of functioning (cognition, mobility, self-care, getting along, life activities, and participation). The CAT-WHODAS 2.0 is also useful for researchers because its scores are comparable with those of the item bank, which consists of 27 items calibrated by the Rasch model.

Importance: Although gamification is recognized for enhancing motivation and learning outcomes, there is a need for specific evidence on how innovative methods, such as educational escape rooms, affect learning experiences and teamwork.

Objective: This study examined the effectiveness of using the educational escape room as an innovative approach for occupational therapy (OT) and occupational therapy assistant (OTA) students.

Design: One-group, preexperimental, pre- and poststudy.

Setting: A simulation laboratory at a university.

Participants: Seventy-six OT and 38 OTA students enrolled in clinical skills classes were randomly assigned to teams of OT and OTA students.

Intervention: An escape room incorporating associated topics covered in the clinical skills course. Students worked collaboratively and applied their combined knowledge and critical thinking skills to solve 10 puzzles to escape in 1 hr.

Outcomes and measures: The Readiness for Interprofessional Learning Scale, Self-Assessment Scale for Active Learning and Critical Thinking, and a researcher-developed knowledge assessment were administered 2 wk before and immediately after the escape room experience to evaluate the students' intraprofessional collaboration, activity learning, critical thinking skills, and knowledge levels.

Results: Students' readiness for teamwork, activity learning, and critical thinking skills increased after participating in the escape room experience. Students' knowledge levels also improved, with a moderate effect size. These results suggest the possible benefits of educational escape rooms.

Conclusions and relevance: Escape rooms are an increasingly popular, innovative teaching modality in health care education. This study validated that escape rooms promote students' learning outcomes and intraprofessional teamwork. Plain-Language Summary: This study assessed the effectiveness of using an escape room as a teaching tool in a clinical skills class for occupational therapy (OT) and occupational therapy assistant (OTA) students. The findings revealed significant improvements in the students' teamwork, active learning, critical thinking skills, and knowledge levels after the escape room experience. These results suggest that incorporating escape rooms into OT education can enhance learning outcomes and should be further explored in future studies with more rigorous experimental designs. This innovative approach benefits students' academic development and can affect OT practice. Fostering collaboration and critical thinking better prepares students to provide comprehensive and effective care to their future clients. This study contributes to the growing body of research that supports active learning pedagogies in OT education, highlighting the importance of engaging

Importance: Debate over the evidence for Ayres Sensory Integration® (ASI) is ongoing; previous reviews have reached mixed conclusions.

Objective: To evaluate the efficacy of ASI for children, based on a systematic review of randomized controlled trials (RCTs).

Data sources: Searches of the Cochrane Library, MEDLINE, CINAHL, PsycINFO, and Embase databases.

Study selection and data collection: We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RCTs were published in peer-reviewed English-language literature and compared implementation of ASI with its Fidelity Measure™ with children ages 0 to 12 yr with treatment as usual, other treatment, or no treatment. Data were extracted using the Template for Intervention Description and Replication Checklist; risk of bias was assessed with the Cochrane risk-of-bias tool for randomized trials.

Findings: Nine RCTs (N = 344 participants), six with autistic children and three with other child populations, were included. RCTs were categorized as Level 1b (well designed) or 2b (low quality); strength of evidence was determined according to U.S. Preventive Services Task Force guidelines. Strong evidence from five RCTs (four Level 1b) indicates that ASI supports autistic children in meeting their individualized goals. Moderate evidence from three RCTs (two Level 1b) indicates no benefits of ASI for behaviors of concern, such as noncompliance or irritability. Bias concerns persist among included studies.

Conclusions and relevance: ASI supports autistic children's individualized goals related to occupational performance, function, and participation. It is not recommended to address behaviors of concern, such as resistance to change or irritability. More research is needed to determine ASI's benefits for other child populations. Plain-Language Summary: Debate over the uses of Ayres Sensory Integration® (ASI) with children accessing occupational therapy is ongoing. Previous systematic reviews used varied and inconsistent definitions of ASI interventions, included mixed methodologies of various quality, and arrived at mixed conclusions. This review addressed these concerns by focusing exclusively on high-level studies of ASI that adhered to the ASI Fidelity Measure™, providing valuable insights into the outcomes of ASI for children (age 0-12 yr). When ASI was conducted under fidelity, the evidence suggested that autistic children significantly improved in their individualized goals related to occupational performance, function, and participation. Research that included outcomes related to behaviors of concern, such as noncompliance or irritability, indicated no benefit of ASI. Emerging evidence reveals some functional and developmental benefits for autistic children and other child populations; further research is needed to support the obser

Importance: Advanced cancer treatments have led to more people wanting to return to work but are unable. Occupational therapists have the skills to address impaired person and environmental factors delaying return to work.

Objective: Describe a three-phase occupational therapy return-to-work intervention based on the Person-Environment-Occupation-Performance (PEOP) model.

Design: Case series.

Setting: Outpatient clinic.

Participants: Adults with brain cancer (N = 3) who completed or were undergoing cancer treatment and wanted to return to work.

Intervention: We evaluated a three-phase occupational therapy approach focusing on restoring self-care skills and advocacy (Phase 1), understanding job demands and developing prework skills (Phase 2), and providing return-to-work support (Phase 3).

Outcomes and measures: Employment status was based on patient self-report. Pre- and postintervention measurements were the 10-item Weekly Calendar Planning Activity; five times sit-to-stand test; Patient Health Questionnaire-9; Saint Louis University Mental Status Examination; Trail Making Test, Dynavision D2 Vision Training System assessment, Bell's Test, and peripheral vision screen.

Results: Each patient returned to work and demonstrated improvements in cognition, physical, mobility, and work-related skills. One transitioned from work to permanent disability after working 8 mo.

Conclusions and relevance: The three-phase occupational therapy approach, based on the PEOP model, considers cognitive and physical impairments and environmental and occupational demands to support persons with brain cancer return to work. The findings provide preliminary support for occupational therapy's involvement within the cancer care continuum to support return to work. Plain-Language Summary: Advances in cancer treatments have led to higher numbers of people with cancer who want to return to work but are unable, leading to financial stress and a reduced personal identity. This case series illustrates how three patients with brain cancer returned to work after participating in a tailored three-phase occupational therapy intervention. Each patient improved their cognitive, physical, mobility, and work skills after completing a three-phase occupational therapy program using rehabilitation and compensatory interventions. Phase 1 focused on restoring self-care skills and teaching about workplace policies. In Phase 2, the patients developed skills that reflected their unique job demands. The occupational therapist provided return-to-work support during Phase 3. These findings provide preliminary support for occupational therapy's early involvement within the cancer-care continuum to support returning to work.

Importance: Persons with Parkinson's disease (PD) become more dependent in activities of daily living (ADL) as the disease progresses. Occupational therapy practitioners aware of the stages of PD can design interventions to promote and maintain occupational performance.

Objective: To evaluate the ADL independence and dependence profiles of patients with PD on the basis of disease stages.

Design: Retrospective observational study.

Setting: Hospital in Japan.

Participants: Patients with PD (N = 209; 75 men and 134 women), with a mean age of 73.3 yr (SD = 7.7).

Outcomes and measures: The Hoehn and Yahr (H-Y) stage was used to determine patients' disease severity. The Barthel Index (BI) was used to determine independence in performing ADLs.

Results: In the H-Y Stage 2 group, the prevalence of independence in mobility and stairs was low, whereas that in other ADLs was high. In the H-Y Stage 3 group, more than half of the patients had limitations in bathing, mobility, and navigating stairs, although most patients remained independent in other ADLs. In the H-Y Stage 4 group, more than half of the patients required assistance with most ADLs, except feeding and bowel control. In the H-Y Stage 5 group, the prevalence of independence during feeding and grooming was relatively high.

Conclusions and relevance: Dependence in ADL domains differs by PD stage, with direct implications for occupational therapy intervention. Plain-Language Summary: Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms and nonmotor symptoms. The disease progression can gradually affect activities of daily living (ADLs), which can lead to decreased independence and quality of life as well as increased caregiver distress. This study evaluated the ADL independence and dependence of patients with PD based on each patient's disease stage. The study found that ADL dependence differs based on the PD stage (mild, moderate, severe), with direct implications for occupational therapy intervention. Occupational therapists can design interventions to improve and maintain the occupational performance of people with PD. Interventions that target ADLs should be based on the patient's PD stage.

Importance: Supporting acquired brain injury (ABI) survivors to find new vocational roles is a critical aspect of vocational rehabilitation. However, it is rarely provided in the United Kingdom and U.K.-based research in this area is lacking.

Objective: To characterize the new vocational roles obtained by ABI survivors who accessed a specialist service (Working Out program) providing rehabilitation and supported employment.

Design: Retrospective descriptive statistical analysis of routinely collected clinical data.

Setting: Community Head Injury Service, Buckinghamshire Healthcare National Health Service Trust, United Kingdom.

Participants: ABI survivors who accessed the Working Out program between 2005 and 2023 and who started a new vocational role during this period.

Outcomes and measures: Role type, role status, industry.

Results: ABI survivors (N = 278; M age = 41.75 yr, SD = 13.09; 24.82% female) obtained a new vocational role. It took on average 1.98 yr (SD = 2.35, range = 0-14) to find an initial new role. Survivors obtained on average 2.79 new vocational roles each (SD = 2.13, range = 1-15). Of the 767 roles for which relevant data were available, 332 (43.29%) were paid, 386 (50.33%) were voluntary, and 49 (6.39%) were education or training roles. The most frequent industry in which a new vocational role was obtained was administrative and support service activities.

Conclusions and relevance: U.K. ABI survivors may be supported to find new vocational roles. However, rehabilitation plus supported employment interventions may be required for an extended duration given the complexity of ABI as a chronic health condition and challenges associated with finding new roles. Plain-Language Summary: People with brain injuries often need support to find new vocational roles after their injury. However, this type of support is rarely provided in the United Kingdom, and U.K.-based research in this area is limited. We analyzed data from a U.K. clinical service that provides rehabilitation and helps people with brain injuries find new jobs. We showed that many people with brain injuries successfully found at least one new job, and many of these new jobs were paid. However, it often took a substantial period of time for them to find a new job.

Importance: Limited availability of Spanish-translated clinical assessment tools perpetuates disparities in health care access for Spanish-speaking Latinos in the United States. The Measure Yourself Medical Outcome Profile® (MYMOP) is a patient-reported outcome measure that has demonstrated utility for use with older Latinos, but a licensed Spanish-language version is not available.

Objective: To develop, validate, and assess the readability of a culturally relevant translation of the MYMOP for U.S. Spanish-speaking Latinos.

Design: A multiphase, systematic translation process involving cognitive debriefing with target respondents and validity and readability analysis.

Setting: Data collected in-person or online within the general Latino community.

Participants: Forty Spanish-speaking volunteers age 45 years or older identifying as Latino/Hispanic, living in the United States, and reporting one or more chronic health conditions were recruited.

Outcomes and measures: The Latin-American Spanish translation of the MYMOP (MYMOP-LAS), a person-centered tool that evaluates overall well-being, symptom severity, and symptom impact on daily activities, was cross-sectionally compared with the EuroQol Five-Dimension Five-Level (EQ-5D-5L) health-related quality of life measure.

Results: Participants found the MYMOP-LAS generally understandable but recommended revisions to improve clarity and alignment with colloquial Spanish. The MYMOP-LAS baseline profile score and three of four subscales correlated significantly with the EQ-5D-5L utility index score (r = -.473 to -.519, ps ≤ .013). The MYMOP-LAS met expectations for readability (approximately fifth-grade reading level).

Conclusions and relevance: Preliminary evidence supports the validity and readability of the MYMOP-LAS for use with the U.S. Latino Spanish-speaking community. Additional research on the MYMOP-LAS's psychometric properties is warranted. Plain-Language Summary: In the United States, there is a shortage of clinical assessment tools for Spanish-speaking Latinos. This study aimed to develop a culturally relevant and readable Latin-American Spanish translation of the Measure Yourself Medical Outcome Profile® 2 (MYMOP-LAS). Forty Latinos age 45 yr and older living in the United States completed and critiqued a draft of the MYMOP-LAS. Participants understood the questionnaire but suggested changes to improve its clarity and alignment with more casual Spanish language. MYMOP-LAS scores aligned with another quality of life measure, corroborating MYMOP-LAS's validity. The tool was readable at about a fifth-grade reading level. This study provides support for using the MYMOP-LAS with Spanish-speaking Latino communities in the United States. Positionality Statement: The authors use Latino or Hispanic as a gender-inclusive te

Importance: Poststroke patients have insufficient voluntary movement that is usually accompanied with spasticity, weakness, and abnormal muscle coactivation. A dynamic spring-loaded orthosis was designed to assist patients' finger movements via a steel wire spring, but relevant evidence for muscle contractions by electromyographic (EMG) activity while the orthosis is worn is lacking.

Objective: To explore muscular activity and muscular coactivation during orthosis use.

Design: A 2 (orthosis condition: wearing vs. free) × 2 (hand condition: affected side vs. unaffected side) mixed repeated-measures experimental design.

Setting: Rehabilitation clinic.

Participants: Thirty participants with a diagnosis of stroke were enrolled.

Outcome and measures: The surface EMG of the flexor digitorum superficialis (FDS) and extensor digitorum common (EDC) was recorded in isometric and dynamic tasks. Two dependent variables, normalized electromyography (nEMG) and cocontraction index (CCI), were calculated.

Results: The nEMG of the EDC and FDS of the affected side were significantly higher in the wearing condition than in the free condition. The nEMG of the EDC of the affected hand was significantly higher than that of the unaffected hand during dynamic activities but not during isometric activities. CCI was significantly lower on the affected side than on the unaffected side in the wearing condition.

Conclusions and relevance: Muscular contraction significantly increased during dynamic orthosis use. The efficacy of the dynamic orthosis in muscle strength training (concentric resistance training of finger flexors and eccentric resistance training of finger extensors) for stroke patients was supported. Plain-Language Summary: People who have experienced a stroke have insufficient voluntary movement that is usually accompanied by spasticity, weakness, and abnormal muscle coactivation. This study explored muscular activity and muscular coactivation for stroke patients using a dynamic spring-loaded hand orthosis that was designed to assist patients' finger movements via a steel wire spring. The study found that muscular contraction significantly increased when the dynamic orthosis was worn than when it was not worn during grasp-and-release tasks. The study results support the efficacy of the dynamic orthosis in muscle strength training for stroke patients. Dexterous movement improvements will contribute to achieving functional independence for poststroke patients.

Importance: Complications of Type 2 diabetes mellitus (T2DM) leading to vision loss may increase the risk of dementia. The relationship between diabetic retinopathy severity and visual acuity (VA) has been explored, but the impact of dementia on vision-related functional performance in patients with T2DM is less understood.

Objective: To investigate the association of diabetes-related eye problems with dementia and the impact of dementia on vision-related quality of life (VRQoL) and activities of daily living (ADLs) in patients with T2DM.

Design: Retrospective cohort and nested case-control study.

Setting: Health care institution.

Participants: Substudy 1 included 4,454 patients with T2DM. In Substudy 2, 33 patients with T2DM and dementia (male, n = 15; M age = 78.7 yr) were compared with 67 matched control participants (male, n = 36; M age = 76.6 yr).

Outcomes and measures: Patients with and without dementia were assessed with the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) and the Revised Self-Report Assessment of Functional Visual Performance (R-SRAFVP).

Results: Substudy 1 showed a borderline significant association between proliferative diabetic retinopathy and dementia. In Substudy 2, functional vision, particularly in the overall scales and three subscales of the R-SRAFVP and four subscales of the NEI-VFQ 25, declined significantly among patients with T2DM and dementia, but no significant differences were found in VA.

Conclusions and relevance: The findings illustrate the complex relationships among T2DM, dementia, VRQoL, and vision-dependent ADL and suggest that occupational therapists who care for patients with T2DM and dementia should pay close attention to patients' functional vision. Plain-Language Summary: Complications of Type 2 diabetes mellitus (T2DM) that lead to vision loss may increase the risk of dementia. People with T2DM and dementia show a significant decline in functional vision. This study investigated the relationship between diabetes-related eye problems and dementia as well as the impact of dementia on vision-related quality of life and activities of daily living for patients with T2DM. The study demonstrates the complex relationships among dementia, T2DM, eye conditions, and vision-related function. The results highlight the importance of a functional vision assessment for patients with T2DM and dementia. Occupational therapists who care for patients with T2DM and dementia should pay close attention to patients' functional vision, which will guide them in assessment and intervention planning.