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American Journal of Occupational Therapy
Journal Prestige (SJR): 0.821
Citation Impact (citeScore): 2
Number of Followers: 172  
 
  Partially Free Journal Partially Free Journal
ISSN (Print) 0272-9490 - ISSN (Online) 1943-7676
Published by AOTA Homepage  [1 journal]
  • Occupational Therapy in Primary Care: Positioned and Prepared to Be a
           Vital Part of the Team
    • Authors: Jordan K.
      Abstract: Reilly’s (1962) now deeply cherished statement that “man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health” (p. 1) was followed a few years later with a question to current and future occupational therapy practitioners. In 1966, Reilly asked how the profession would respond to the challenges of an expanding knowledge base, accelerating health care costs, and escalating regulatory burden. Visionary Wilma West, a contemporary of Reilly’s, expanded on these themes by focusing on ways occupational therapy practitioners could leverage the breadth and depth of their practice to confront these challenges. These issues are now paramount in the primary care arena. An expanding body of literature, including the articles in a special section in this issue of the American Journal of Occupational Therapy, supports occupational therapy’s role as a vital part of the solution to contemporary health care challenges. Occupational therapy practitioners are educationally prepared and successfully poised through policy to engage in evidence-based practice in the primary care environment.
      PubDate: Mon, 26 Aug 2019 00:00:00 GMT
       
  • Pilot Study of Let’s Get Organized: A Group Intervention for
           Improving Time Management
    • Authors: Holmefur M; Lidström-Holmqvist K, Roshanay A, et al.
      Abstract: Importance: There is a need for evidence-based occupational therapy interventions to enhance time management in people with time management difficulties.Objective: To pilot test the first part of the Let’s Get Organized (LGO) occupational therapy intervention in a Swedish context by exploring enhancements of time management skills, aspects of executive functioning, and satisfaction with daily occupations in people with time management difficulties because of neurodevelopmental or mental disorders.Design: One-group pretest–posttest design with 3-mo follow-up.Setting: Outpatient psychiatric and habilitation settings.Participants: Fifty-five people with confirmed or suspected mental or neurodevelopmental disorder and self-reported difficulties with time management in daily life.Intervention: Swedish version of Let’s Get Organized (LGO–S) Part 1, with structured training in the use of cognitive assistive techniques and strategies using trial-and-error learning strategies in 10 weekly group sessions of 1.5 hr.Outcomes and Measures: Time management, organization and planning, and emotional regulation were measured with the Swedish version of the Assessment of Time Management Skills (ATMS–S). Executive functioning was measured with the Swedish version of the Weekly Calendar Planning Activity, and satisfaction with daily occupations was assessed with the Satisfaction With Daily Occupations measure.Results: Participants displayed significantly improved time management, organization and planning skills, and emotional regulation, as well as satisfaction with daily occupations. Aspects of executive functioning were partly improved. ATMS–S results were sustained at 3-mo follow-up.Conclusion and Relevance: LGO–S Part 1 is a promising intervention for improving time management skills and satisfaction with daily occupations and should be investigated further.What This Article Adds: This study shows that LGO–S Part 1 is feasible for use in psychiatric and habilitation outpatient services. The results are promising for improved time management skills, organization and planning skills, and satisfaction with daily occupations and need to be confirmed in further studies.
      PubDate: Fri, 23 Aug 2019 00:00:00 GMT
       
  • Influence of Lifestyle Redesign ® on Health, Social Participation,
           Leisure, and Mobility of Older French-Canadians
    • Authors: Levasseur M; Filiatrault J, Larivière N, et al.
      Abstract: Importance: Developed in California to enable community-dwelling older adults to maintain healthy and meaningful activities, Lifestyle Redesign® is a well-known cost-effective preventive occupational therapy intervention. The impact of a newly adapted French version on older French-Canadians was, however, unknown.Objective: To explore the influence of Lifestyle Redesign on older French-Canadians’ health, social participation, leisure, and mobility.Design: A mixed-methods design included a preexperimental component (questionnaires administered before and after the intervention and 3 and 6 mo postintervention) and an exploratory descriptive qualitative clinical study. Individual semidirected interviews were digitally audiotaped and transcribed, then underwent thematic content analysis using mix extraction grids.Setting: Community.Participants: Sixteen volunteers (10 women) aged 65–90 yr (mean = 76.4, standard deviation = 7.6), 10 without and 6 with disabilities. Inclusion criteria were age ≥65 yr, normal cognitive functions, residence in a conventional or senior home, and French speaking.Intervention: French-Canadian 6-mo version of Lifestyle Redesign.Outcomes and Measures: Health, social participation, leisure, and mobility were measured using the 36-item Short Form Health Survey, Social Participation Scale, Leisure Profile, and Life-Space Assessment, as well as a semistructured interview guide.Results: The French-Canadian Lifestyle Redesign had a beneficial effect on participants’ mental health (p = .02) and interest in leisure (p = .02) and, in those with disabilities, social participation (p = .03) and attitudes toward leisure (p = .04). Participants reported positive effects on their mental health, leisure, mobility, and social participation, including frequency and quality of social interactions, and indicated that having an occupational routine fostered better health. None of the participants reported no effect.Conclusion and Relevance: The translated and culturally adapted Lifestyle Redesign is a promising occupational therapy intervention for community-dwelling older French-Canadians.What This Article Adds: This study sheds light on the influence of the French-Canadian version of the intervention not only on older adults’ health and social participation but also on their leisure activities and life-space mobility, two important outcomes not addressed in previous Lifestyle Redesign studies. Moreover, this study provides an in-depth understanding of the Lifestyle Redesign experience of French-Canadian older adults with and without disabilities, including participants with significant communication and mobility disabilities.
      PubDate: Tue, 20 Aug 2019 00:00:00 GMT
       
  • Somatosensory Discrimination in People With Autism Spectrum Disorder: A
           Scoping Review
    • Authors: Zetler N; Cermak SA, Engel-Yeger B, et al.
      Abstract: Importance: Sensory symptoms in people with autism spectrum disorder (ASD) are commonly reported by researchers. However, an often overlooked sensory aspect of ASD is sensory discrimination in general, and somatosensory discrimination in particular.Objective: To examine what has and what has not yet been learned concerning the somatosensory discrimination abilities of people with ASD and to reveal gaps warranting further research.Design: Scoping review of clinical studies published 1995–2017 located through searches of PsycNET, PubMed, ERIC, and Google Scholar. Inclusion criteria were English-language peer-reviewed studies with (1) participants diagnosed with ASD, (2) a specific somatosensory discrimination measure, and (3) a comparison group. No age or intellectual exclusion criteria were established; studies were excluded if they were theoretical or descriptive, did not incorporate a control group, focused only on neurology or genetics, or used simple threshold detection measures or somatosensory measures integrated with other measures. The final search yielded 12 comparative articles discussing tactile and proprioceptive discrimination in people with ASD.Results: Overall, most results showed atypical somatosensory discrimination in people with ASD, especially among young children. The relationship between sensory discrimination abilities and other sensory symptoms and ASD symptoms is briefly discussed.Conclusions and Relevance: Heterogeneous findings concerning somatosensory discrimination in people with ASD shed light on underlying mechanisms of these disorders and can contribute to improvement of occupational therapy intervention for this population.What This Article Adds: The occupational therapy evaluation of people with ASD can benefit from addressing somatosensory discrimination and its contribution to other clinical symptoms. This type of assessment can help improve intervention strategies for people with ASD by promoting a focus on the effect of discrimination deficits on daily function.
      PubDate: Mon, 19 Aug 2019 00:00:00 GMT
       
  • Examining Primary Care Health Encounters for Adults With Autism Spectrum
           Disorder
    • Authors: Stein Duker LI; Sadie Kim H, Pomponio A, et al.
      Abstract: OBJECTIVE. Our objective was to identify perceived barriers and strategies to improve primary care encounters, as reported by adults with autism spectrum disorder (ASD), caregivers of adults with ASD, and primary care providers (PCPs) treating adults with ASD.METHOD. As part of a larger mixed-methods design, adults with ASD, caregivers, and PCPs (N = 78) in Los Angeles and Philadelphia completed surveys examining barriers to care and strategies to improve care.RESULTS. Multiple barriers to care were reported by adults with ASD and caregivers, including communication and sensory challenges. Adults with ASD and caregivers reported minimal use of strategies during primary care visits but indicated that those used were helpful during care. Expert PCPs reported using strategies more frequently than novice PCPs. All respondent groups endorsed that strategies had the potential to improve care in the future for adults with ASD.CONCLUSION. Opportunities exist for occupational therapy collaboration in primary health care and primary care education to improve care for adults with ASD.
      PubDate: Mon, 19 Aug 2019 00:00:00 GMT
       
  • Addressing Diabetes in Primary Care: Hybrid Effectiveness–Implementation
           Study of Lifestyle Redesign ® Occupational Therapy
    • Authors: Pyatak E; King M, Vigen CP, et al.
      Abstract: Importance: Primary health care is rapidly developing as an occupational therapy practice area. Yet, to date, little evidence supports occupational therapy’s feasibility and efficacy in primary care settings.Objective: To report on the implementation and preliminary clinical outcomes of a Lifestyle Redesign® (LR)–occupational therapy (LR–OT) diabetes management intervention in a primary care clinic.Design: Patients were randomized to be offered LR–OT or to a no-contact comparison group (data not reported). We assessed implementation outcomes using mixed methods.Setting: Safety-net primary care clinic.Participants: Clinic providers and staff; English- or Spanish-speaking clinic patients ages 18–75 yr with diabetes and a current hemoglobin A1c (HbA1c) ≥ 9.0%.Intervention: Eight 1-hr individual sessions of LR–OT focused on diabetes management.Outcomes and Measures: Clinical and health behavior outcomes were assessed via electronic medical record (EMR) review and self-report surveys of patients receiving LR–OT at initial evaluation and discharge. We assessed implementation outcomes (acceptability, appropriateness, feasibility, fidelity, efficiency, and timeliness) using patient and staff surveys, interviews, focus groups, and observations.Results: Seventy-three patients were offered LR–OT: 51 completed one or more sessions, and 38 completed the program. Clinical outcomes among program completers indicate beneficial changes in HbA1c, diabetes self-care, and health status. Implementation challenges included a need for patient and staff education, securing adequate workspace, and establishing a referral process. Factors contributing to implementation success included strong buy-in from clinic leadership, colocation, and shared EMR documentation.Conclusions and Relevance: LR–OT is a feasible approach to enhancing service delivery and clinical outcomes in primary care.What This Article Adds: This study provides insight into factors that may create challenges or contribute to the success of implementing occupational therapy services within primary health care settings. In addition, this study provides preliminary evidence of occupational therapy’s effectiveness in improving clinical outcomes among ethnically diverse, low-income patients with diabetes in a safety-net primary care setting.
      PubDate: Mon, 19 Aug 2019 00:00:00 GMT
       
  • Narrowing the Gap: An Implementation Science Research Agenda for the
           Occupational Therapy Profession
    • Authors: Juckett LA; Robinson ML, Wengerd LR.
      Abstract: Despite advancements in occupational therapy research, the widespread research-to-practice gap continues to delay how quickly evidence-based practices are implemented in real-world clinical settings. Implementing research in practice is a complex process that mandates attention from all occupational therapy stakeholders; however, researchers are uniquely positioned to help minimize the 17-yr lag between scientific discovery and the implementation of research findings into practice. Our article serves as a response to Marr’s (2017) Centennial Topics article, which proposed that purposeful efforts are needed to advocate for implementation research in occupational therapy. We provide an implementation science research agenda informed by concepts from the implementation science literature and suggest how researchers can structure methodologies to examine implementation-related outcomes and strategies. We provide explanations of gold-standard implementation outcomes and offer several recommendations for how researchers can report and disseminate implementation research findings to occupational therapy stakeholders.
      PubDate: Thu, 25 Jul 2019 00:00:00 GMT
       
  • Reference Values for the Adolescent/Adult Sensory Profile in Spain
    • Authors: Gándara-Gafo B; Santos-del Riego S, Muñiz J.
      Abstract: Importance: In Spain, only one culturally adapted assessment tool is available for children between ages 3 and 11 yr. There are no assessments of adolescent and adult sensory processing, and no normative data.Objective: To obtain reference values for the Adolescent/Adult Sensory Profile (AASP) in Spain for adolescents (aged 11–17) and adults (aged 18–64 and ≥65).Design: A multivariate analysis of variance was used to compare specific mean values (−2, −1, +1, and +2 standard deviation [SD]) by age group, gender, geographic area, education level, and employment status.Participants: We randomly recruited 787 participants (55.8% female) aged 11 yr or older (mean age = 32.1, SD = 21.1) in Spain. We excluded those with a diagnosis of depression, chronic disease (e.g., diabetes, cancer, neurological disease), or cognitive disability and those who used medication that could affect the central nervous system.Results: Quadrant mean (SD) scores ranged from 29.3 (6.6) for low registration to 49.1 (8.3) for sensory seeking, with significant differences by age group (p < .001) in all quadrants. Significant differences were also found for scores in different quadrants by gender, geographic area, education level, and employment status. Although statistically significant, the differences between scores were not clinically relevant; the mean scores fell within the typical range for sensory processing.Conclusions and Relevance: We offer reference values for the cultural adaptation to Spain of the AASP and recommend its use for the typically developing Spanish population ages 11 and older.What This Article Adds: We provide normative data for the AASP for three age groups of the Spanish population: adolescents, adults, and older adults.
      PubDate: Wed, 17 Jul 2019 00:00:00 GMT
       
  • Occupational Therapy Student Learning on Interprofessional Teams in
           Geriatric Primary Care
    • Authors: Halle AD; Kaloostian C, Stevens GD.
      Abstract: Importance: Geriatric, interprofessional primary care training for occupational therapy students is needed.Objective: To measure occupational therapy student–reported knowledge, attitudes, and skills after participation in interprofessional geriatric educational programs.Design: Prospective, observational study with pre- and posttests for the three programs.Participants: Fifty-nine entry-level and postprofessional occupational therapy master’s students.Outcomes and Measures: Self-reported familiarity with other professionals’ roles, perceptions of interprofessional training, capabilities to conduct assessments, and attitudes of older adults.Results: Students of the three programs (Interprofessional Geriatrics Curriculum [IPGC], Student Senior Partnership Program [SSPP], and Geriatric Assessment Program [GAP]) reported different improvements in familiarity of roles, capabilities of assessment, and Geriatric Attitudes Scale (GAS) scores. For example, IPGC and SSPP students had changes in total GAS score (3.91–4.08, p = .002, and 3.84–3.99, p = .003, respectively), but no change was found for GAP students (3.85–3.91, p = .523).Conclusions and Relevance: More structured interprofessional education with older adults appeared to help prepare occupational therapy students to work on geriatric interprofessional teams in primary care.What This Article Adds: This article expands on growing evidence to support occupational therapy’s role in primary care by addressing the need to train future generations to work on interprofessional geriatric primary care teams.
      PubDate: Wed, 17 Jul 2019 00:00:00 GMT
       
  • Occupational Therapy Interventions for Urinary Dysfunction in Primary
           Care: A Case Series
    • Authors: Cunningham R; Valasek S.
      Abstract: Urinary dysfunction is commonly reported in primary care contexts. A shortage of primary care providers is affecting access to relevant services. Occupational therapy practitioners work in primary care settings and typically address urinary dysfunction in an outpatient context. Evidence regarding the delivery of occupational therapy interventions for urinary dysfunction in primary care has been limited. In this study, 3 women received 9–14 occupational therapy sessions in a primary care setting to address urinary symptoms. Plan-of-care duration, assessments, and urinary dysfunction interventions were individualized to accommodate personal and environmental factors. Across all case-series participants, Canadian Occupational Performance Measure scores demonstrated clinically significant improvement. Mixed results were found for SF–36 health-related quality-of-life subscale scores. Assessment scores specific to urinary dysfunction decreased, indicating reduced symptom severity and functional impact. This article provides preliminary evidence regarding the feasibility of occupational therapy interventions addressing urinary dysfunction in primary care settings.
      PubDate: Wed, 17 Jul 2019 00:00:00 GMT
       
  • A National Survey of Learning Activities and Instructional Strategies Used
           to Teach Occupation: Implications for Signature Pedagogies
    • Authors: Krishnagiri S; Hooper B, Price P, et al.
      Abstract: Importance: Occupational therapy practitioners’ professional identities and distinctive contributions to health care connect essentially to their knowledge of occupation. Thus, the strategies educators use to convey occupation to students and the perspectives embedded in those strategies are critical topics for researchers.Objective: To generalize findings from a previous qualitative study of how educators in 25 U.S. occupational therapy assistant and occupational therapy programs addressed occupation to a national sample of educators.Design: As part of an exploratory sequential design, a national survey of U.S. occupational therapy and occupational therapy assistant educators explored activities and strategies used to teach occupation. Data were analyzed using descriptive statistics.Setting: An online survey about educators’ practices in the academic education setting.Participants: Occupational therapy and occupational therapy assistant educators (N = 1,590) from all programs in the United States. Of these, 634 returned surveys, 315 of which were complete and included in the analysis, for an overall response rate of 19.8%.Results: Respondents identified similar learning activities and instructional strategies as those identified in the qualitative phase of the design. Most instruction was active and experiential, requiring students to integrate various skills and content areas. Definitions of occupation, as a basis for teaching, varied.Conclusions and Relevance: The combined survey and qualitative results offered initial empirical support for occupational therapy’s proposed signature pedagogies and the importance of attending to the deep and implicit structures within those pedagogies. Such structures are believed to support students’ formation of a professional identity and an occupational perspective.What This Article Adds: This study provides evidence for the instructional strategies that educators use to convey knowledge of occupation to students. The predominant strategies support proposed signature pedagogies in occupational therapy: relational learning, affective learning, and highly contextualized active learning.
      PubDate: Mon, 15 Jul 2019 00:00:00 GMT
       
  • Health Through Activity: Initial Evaluation of an In-Home Intervention for
           Older Adults With Cancer
    • Authors: Lyons K; Bruce ML, Hull JG, et al.
      Abstract: OBJECTIVE. The objective of this study was to assess the feasibility of conducting a future full-scale trial to test the efficacy of an in-home occupational therapy intervention designed to reduce disability in older adult cancer survivors.METHOD. Participants reporting activity limitations during or after cancer treatment were enrolled in a Phase 1 pilot randomized controlled trial comparing the 6-wk intervention (n = 30) to usual care (n = 29). Descriptive data on retention rates were collected to assess feasibility of intervention and study procedures. Potential efficacy was explored through participants’ self-reported disability, quality of life, activity level, and behavioral activation at 0, 8, and 16 wk after enrollment.RESULTS. Retention rates were high regarding completion of the intervention (90%) and outcome assessments (90% of usual-care participants and 80% of intervention participants). Outcomes consistently favored the intervention group, although group differences were small.CONCLUSION. The procedures were feasible to implement and acceptable to participants.
      PubDate: Mon, 15 Jul 2019 00:00:00 GMT
       
  • Occupational Therapy Interventions for Adults Living With Serious Mental
           Illness
    • Authors: Lannigan E; Noyes S.
      Abstract: Occupational therapy practitioners have education, skills, and knowledge to provide occupational therapy interventions for adults living with serious mental illness. Evidence-based interventions demonstrate that occupational therapy practitioners can enable this population to engage in meaningful occupations, participate in community living, and contribute to society. Systematic review findings for occupational therapy interventions for adults living with serious mental illness were published in the September/October 2018 issue of the American Journal of Occupational Therapy and in the Occupational Therapy Practice Guidelines for Adults Living With Serious Mental Illness. Each article in the Evidence Connection series summarizes evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. These articles illustrate how research evidence from the reviews can be used to inform and guide clinical decision making. Through a case story, this article illustrates how current evidence is applied for effective occupational therapy intervention with an adult living with serious mental illness.
      PubDate: Thu, 11 Jul 2019 00:00:00 GMT
       
  • Identifying Homogeneous Outcome Groups in Adult Rehabilitation Using
           Cluster Analysis
    • Authors: Custer MG; Huebner RA.
      Abstract: Importance: Adults receiving occupational therapy in inpatient rehabilitation are a heterogeneous population with differing needs, outcomes, and rehabilitation processes. Outcome studies based on what works for all clients may obscure the needs of population subgroups who benefit unequally from rehabilitation services.Objective: To identify subgroups on the basis of client satisfaction and progress in functional self-care among a diverse rehabilitation population and to understand subgroup differences in occupational therapy and rehabilitation processes and client discharge status.Design: Using an existing dataset, we used K-means cluster analysis of demographics, status at admission, and the outcomes of satisfaction and change in self-care to identify five homogeneous outcome groups. Occupational therapy and rehabilitation processes and discharge status were compared across subgroups.Setting: Inpatient rehabilitation hospital.Participants: The dataset included 1,099 inpatients age 18 yr and older who received occupational therapy over a 27-mo period.Measures: Admission measures included the Inpatient Rehabilitation Facility–Patient Assessment Instrument and self-care items of the FIM™. The Satisfaction with Continuum of Care–Revised was administered after discharge.Results: Five subgroups showed statistically different patterns of medical complications, functional self-care, rates of progress, satisfaction with intervention, and course of treatment. The profile of each group suggests differing therapeutic needs. Although all groups made significant gains in functional self-care, two groups continued to need physical assistance at discharge.Conclusions and Relevance: Cluster analysis proved useful in segmenting a typical heterogeneous rehabilitation population into more homogeneous subgroups to enhance understanding of clinical needs and to potentially increase the potency of outcomes research.What This Article Adds: This research identified subgroups within a typical population of rehabilitation clients receiving occupational therapy and identified their unique needs and outcomes using cluster analysis techniques.
      PubDate: Thu, 11 Jul 2019 00:00:00 GMT
       
  • Evaluation of an Occupation-Based Retreat for Women After Pregnancy or
           Infant Loss
    • Authors: Hanish K; Margulies I, Cogan AM.
      Abstract: Importance: Pregnancy loss and infant death are unexpected, traumatic, life-changing events. The role of occupational therapy practitioners in treating this population is not well defined.Objective: To describe the outcomes of an occupation-based residential retreat for women who have experienced pregnancy or infant loss.Design: Program evaluation.Setting: Seven residential retreats for bereaved mothers.Participants: One hundred forty-one women who experienced perinatal loss.Intervention: Residential retreats that were held in natural settings and included occupation-based activities such as group discussions, yoga, meditation, crafts, and rituals to facilitate grieving and healing processes after perinatal loss.Outcomes and Measures: The Beck Depression Inventory, PTSD Checklist–Civilian Version, Self-Compassion Scale, and Multidimensional Scale of Perceived Social Support were collected pre- and postretreat.Results: Statistically significant improvements were seen in women’s depression, trauma, self-compassion, and perceived social support from pre- to postretreat.Conclusions and Relevance: At present, occupational therapy practitioners support this population primarily by providing referrals and information about local resources. However, as occupational therapy practice in primary care settings grows, so too do possibilities for the development of occupational therapy–related interventions to support maternal mental health.What This Article Adds: This article provides preliminary support for occupation-based retreats as a treatment for improving maternal mental health after perinatal loss.
      PubDate: Mon, 08 Jul 2019 00:00:00 GMT
       
  • Opportunities for Occupational Therapy on a Primary Care Team
    • Authors: Winship JM; Ivey CK, Etz RS.
      Abstract: Importance: Leaders in the occupational therapy profession have called for occupational therapy’s inclusion in primary care, but little is known about the occupational needs of patients in this setting.Objective: To explore the need for and potential role of occupational therapy in a team-based primary care clinic.Design: A qualitative descriptive study using a convenience sample of clinicians and patients. Meetings and semistructured interviews were recorded, transcribed, and coded by multiple coders using a general immersion–crystallization approach to identify relevant themes.Setting: Outpatient complex care clinic of an urban academic medical center.Participants: The study included a voluntary sample of clinicians and patients from the complex care clinic. Patients were recruited from a staff-provided list; eligible patients had attended the clinic for at least 1 yr. All patients had multiple chronic conditions and were uninsured or received Medicaid.Results: Researchers attended 10 clinician team meetings and conducted 13 patient interviews and 10 clinician interviews. Four domains of patient need were identified by both patients and clinicians: complex medical management, patients’ limited resources, mental health needs, and challenges to occupation. Clinicians also identified cognitive–behavioral challenges affecting care, including lack of engagement and poor problem solving.Conclusions and Relevance: The makeup of the clinic team reflected their intent to address medical, socioeconomic, and mental health domains. However, cognitive–behavioral challenges and patients’ occupational limitations were not consistently addressed. Thus, patients had unmet needs that occupational therapy practitioners were qualified to address.What this Article Adds: This study adds to the available literature examining patient needs and clinician challenges in a primary care clinic. Patients have occupational needs that are not being addressed in primary care, indicating a need for occupational therapy in this setting.
      PubDate: Mon, 08 Jul 2019 00:00:00 GMT
       
  • Shoulder Pain Among Patients With Amyotrophic Lateral Sclerosis: A Case
           Series
    • Authors: Gicalone AR; Heckman MG, Otto E, et al.
      Abstract: Importance: Evidence has demonstrated that shoulder pain constitutes a functional impairment for patients with amyotrophic lateral sclerosis (ALS). No studies have yet examined the efficacy of scapular mobilization of the painful shoulder among patients with ALS.Objective: Our retrospective case series evaluated the effects of scapular mobilization on pain and shoulder motion among patients with ALS.Design: Retrospective case series over 2 yr.Setting: A multidisciplinary outpatient clinic at an academic medical institution.Participants: Twenty-eight patients with ALS who had shoulder pain and range of motion (ROM) limitations. Patients were excluded if information on visual analog scale (VAS) score for pain and shoulder ROM was not available.Intervention: Scapular mobilization, ROM, and caregiver education. All patients also received standard occupational therapy treatment for this patient population.Outcomes and Measures: The primary outcome was VAS shoulder pain scores; the secondary outcome was shoulder flexion ROM.Results: The median VAS pain score was 2 before treatment and 0 after treatment, with a significant median reduction of 2. Median shoulder flexion ROM was 100° before mobilization treatment and 130° after treatment, with a significant median increase of 25°.Conclusion and Relevance: The results provide strong evidence that both VAS pain score and shoulder ROM noticeably improve after mobilization treatment.What This Article Adds: Occupational therapists can effectively promote shoulder care techniques such as scapular mobilization to both patients and care providers to reduce pain and improve quality of life for patients with ALS.
      PubDate: Fri, 05 Jul 2019 00:00:00 GMT
       
  • Visual Field Impairment and Driver Fitness: A 1-Year Review of Crashes and
           Traffic Violations
    • Authors: Kristalovich L; Ben Mortenson WW.
      Abstract: Importance: Occupational therapists frequently assess the fitness to drive of people with visual field impairment, but the relationship between these assessments and driving performance over time is not well understood.Objective: To determine traffic violation and crash incidence over a 1-yr period for drivers with visual field impairment.Design: Retrospective review of medical and driving records.Setting: British Columbia, Canada.Participants: Participants (N = 445) were ages 26–74 yr with binocular, corrected visual acuity of ≥20/50. Goldmann visual field tests were reviewed to stratify participants on the basis of visual field impairment and whether impairments exceeded licensing standards.Outcome and Measures: Traffic records were reviewed to determine group-specific traffic violations and crash incidence during the year after the visual field test.Results: Of 445 participants, 292 held a valid driver’s license during the designated period. Participants not meeting the licensing standards were less likely to become licensed than participants who met the standards. The results indicate that drivers with visual field impairment did not have a higher probability of crashes or violations than drivers without visual field impairment.Conclusion: Drivers with visual field impairment who retained a driver’s license did not have an increased probability of crashes in the following year. A larger, prospective, mixed methods study of long-term driving behaviors among people with visual field impairment is recommended.What This Article Adds: This study provides preliminary data on the 1-yr incidence of traffic violations and crashes among people with visual field impairment.
      PubDate: Fri, 05 Jul 2019 00:00:00 GMT
       
  • Complex Task Performance Assessment (CTPA) and Functional Cognition in
           People With Parkinson’s Disease
    • Authors: Davis A; Wolf TJ, Foster ER.
      Abstract: OBJECTIVE. The objective of this study was to determine how Parkinson’s disease (PD) affects functional cognition as assessed by the Complex Task Performance Assessment (CTPA) and to examine the associations of CTPA performance with other indicators of executive function in people with PD.METHOD. Volunteers with PD without dementia (n = 20) and community control participants (n = 19) completed neuropsychological testing, patient-reported outcome measures, and the CTPA.RESULTS. There were no group differences for CTPA performance accuracy; however, the PD group took longer to complete the CTPA than did the control group. In the PD group, inefficient CTPA performance correlated with poorer cognitive flexibility and worse reported everyday shifting and task monitoring.CONCLUSION. Decreased executive function, namely cognitive flexibility and attentional control, may impair functional cognition in people with PD. Future studies with larger, more diverse samples are warranted to determine the discriminant validity and sensitivity of the CTPA. Use of performance-based assessments such as the CTPA may increase the understanding of functional cognition in people with PD.
      PubDate: Fri, 05 Jul 2019 00:00:00 GMT
       
  • Primary Care Occupational Therapy: How Can We Get There' Remaining
           Challenges in Patient-Centered Medical Homes
    • Authors: Pape SB; Muir S.
      Abstract: Passage of the Patient Protection and Affordable Care Act in 2010 mandated reform of the United States’ existing primary care system. As part of this reform, advanced practice models, including the Patient-Centered Medical Home model, expanded, with the goal of increasing the use of interprofessional teams. Integrating occupational therapy was promoted as an opportunity to enhance the value of care provided in these redesigned primary care practices. However, occupational therapy’s presence in primary care is still extremely limited.
      PubDate: Fri, 05 Jul 2019 00:00:00 GMT
       
 
 
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