American Journal of Occupational Therapy最新文献

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.

Importance: There are currently 55 million adults living with declining functional cognition-altered perception, thoughts, mood, or behavior-as the result of Alzheimer's disease (AD) and related neurocognitive disorders (NCDs). These changes affect functional performance and meaningful engagement in occupations. Given the growth in demand for services, occupational therapy practitioners benefit from consolidated evidence of effective interventions to support adults living with AD and related NCDs and their care partners.

Objective: These Practice Guidelines outline effective occupational therapy interventions for adults living with AD and related NCDs and interventions to support their care partners.

Method: We synthesized the clinical recommendations from a review of recent systematic reviews.

Results: Twelve systematic reviews published between 2018 and 2021 served as the foundation for the practice recommendations.

Conclusion and recommendations: Reminiscence, exercise, nonpharmacological behavioral interventions, cognitive therapy, sensory interventions, and care partner education and training were found to be most effective to support adults living with AD and related NCDs. Plain-Language Summary: These Practice Guidelines provide strong and moderate evidence for occupational therapy practitioners to support adults living with Alzheimer's disease (AD) and related neurocognitive disorders (NCDs) and their care partners. They provide specific guidance for addressing the decline in cognition, behavioral and psychological symptoms of dementia, and pain experience of adults living with AD and related NCDs. The guidelines also describe interventions to support care partners. With support from the evidence, occupational therapy practitioners are better equipped to address the unique needs of adults living with AD and related NCDs and their care partners.

Importance: No single cognitive screen adequately captures all cognitive domains that are important for inpatient occupational therapy treatment planning.

Objective: To quantify the content validity of a novel 22-item cognitive screen, the Gaylord Occupational Therapy Cognitive (GOT-Cog) screen, developed to better inform inpatient occupational therapy treatment planning.

Design: Delphi-style expert panel review.

Setting: Long-term acute care hospital.

Participants: The first panel was attended by four occupational therapists, two speech-language pathologists, one physician assistant, and two neuropsychologists; the second, by four occupational therapists, one speech-language pathologist, and one physician assistant.

Intervention: Each Delphi panel discussed the relevance, essentiality, and clarity of each item. After each discussion, panelists completed a content validity survey to summarize their evaluation of each item.

Outcomes and measures: On the basis of panelists' survey responses, item- and scale-level relevance, essentiality, and clarity were quantified by calculating the respective content validity index (CVI), content validity ratio (CVR), and content clarity index (CCI). Universal agreement (UA) and κ statistics were also calculated, as appropriate.

Results: Upon presenting the initial 23-item instrument covering 10 cognitive domains to the first Delphi panel, several questions were added, removed, or rewritten, resulting in a 22-item instrument representing nine domains. After the second panel, several questions were again rewritten, and the domains reorganized. All scale-level metrics improved, including CVI (from 0.87 to 1.0), UA (0.52 to 1.0), CVR (0.43 to 0.94), and CCI (2.26 to 2.92).

Conclusions and relevance: GOT-Cog displays overall excellent content validity and can proceed to construct validity testing. Plain-Language Summary: By reporting on the content validity of the Gaylord Occupational Therapy Cognitive screen, this brief report begins the necessary process of evaluating the measure's overall validity and reliability.

Importance: Implementing evidence-based practice (EBP) is essential for ensuring optimal quality care and obtaining positive outcome in treatment. Occupational therapists generally hold positive attitudes toward EBP; however, EBP is not always fully implemented.

Objective: To explore the mediating role of self-efficacy on the relationship between implementing EBP and burnout among occupational therapists.

Design: A cross sectional study.

Setting: Data were collected through social media and WhatsApp groups using an online survey accessible through Qualtrics, a secured web-based data collection system; responses were anonymous.

Participants: The final sample consisted of 261 female Israeli occupational therapists (ages 24-65 yr, with 1-40 yr of clinical experience).

Outcomes and measures: The following questionnaires assessed EBP implementation, burnout, and self-efficacy, respectively: the EBP Implementation Scale, the Maslach Burnout Inventory, and the Occupational Therapy Self-Efficacy Questionnaire. Demographic data were also collected.

Results: EBP implementation was low (0-43 points out of a maximum 72 points), moderate levels of burnout and high levels of self-efficacy were reported. Significant associations with medium effect sizes were found between EBP implementation and burnout: the higher the levels of EBP implementation, the lower the levels of burnout frequency and intensity. Moreover, self-efficacy mediated these relationships. EBP implementation was related to elevated self-efficacy, which, in turn, was associated with lower burnout.

Conclusions and relevance: EBP implementation may serve as an important tool to limit burnout among occupational therapists by fostering their trust in their ability to handle clinical challenges. Further research is needed. Plain-Language Summary: This study explored implementing evidence-based practice (EBP) and its relationships to burnout and work-related self-efficacy among occupational therapists. The study found that self-efficacy mediated the relationships between implementing EBP and burnout. Implementing EBP was associated with higher self-efficacy, which, in turn, was associated with lower burnout among occupational therapists.