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First page: 7701205030 Abstract: AbstractImportance: Occupational therapists require valid cognitive fitness-to-drive tools to advise drivers in this high-stakes area.Objective: To examine the psychometric properties and predictive validity of data gathered with the touchscreen DriveSafe DriveAware (DSDA).Design: Prospective study that compared a screening tool with a criterion standard.Setting: Ten community- and hospital-based driver assessment clinics in Australia and New Zealand.Participants: Older and cognitively impaired drivers (N = 134) ages 18 to 91 years (Mage= 68) who were referred for an assessment to determine the impact of a medical condition on driving. The inclusion criteria were a valid driver’s license, vision within license authority guidelines, completion of at least 1 year of high school, and English as a first language.Outcomes and Measures: The results of the touchscreen DSDA, a standardized assessment of awareness of the driving environment and one’s own driving abilities, were compared with those of a standardized occupational therapist–administered on-road assessment.Results: Rasch analysis provided evidence for the construct validity and internal reliability of data gathered with the touchscreen DSDA. Optimal upper and lower cutoff scores were set to trichotomize drivers into three categories: likely to pass an on-road assessment, likely to fail an on-road assessment, and further testing required. Specificity of the touchscreen DSDA was 86%, and sensitivity was 91%; positive predictive value was 83%, negative predictive value was 92%, and overall accuracy of classification was 88%.Conclusions and Relevance: Evidence supports the utility of the touchscreen DSDA for accurately predicting which participants require on-road assessment.What This Article Adds: The touchscreen DSDA is a promising screen for occupational therapists and other health professionals to use in conjunction with other clinical indicators to determine whether drivers require further assessment. PubDate: Mon, 30 Jan 2023 00:00:00 GMT DOI: 10.5014/ajot.2023.050048 Issue No:Vol. 77, No. 1 (2023)
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First page: 7701205060 Abstract: AbstractImportance: Occupational therapy practitioners working in mental health settings in the United States are faced with challenges and barriers to implementing justice-oriented, occupation-centered practice. Research situated in the practice context with practitioners as coresearchers may provide an avenue for changing practice.Objective: To describe the reconceptualization and redesign of occupational therapy services by a community of occupational therapy practitioners in an acute mental health setting in the United States.Design: Practice-based inquiry, a form of practitioner-generated action research with a community of practice scholars (CoPS), guided the redesign of practice.Setting: Acute mental health service in a large teaching hospital system.Participants: Nine occupational therapists comprised a CoPS and served as coresearchers and participants in the study.Data Collection and Analysis: Practitioner scholars’ experiences of daily practice captured in individual reflections and collective research discussions were the source of data. Data collection, analysis, and action was an iterative process. Coresearchers coded and categorized findings and then developed themes reflecting changes enacted in practice.Findings: The data analysis resulted in two themes characterizing how the CoPS reconceptualized and redesigned practice to reflect their commitment to occupation-centered and justice-focused occupational therapy: (1) occupational opportunities through direct services and (2) occupational opportunities through system-level change.Conclusions and Relevance: For this CoPS, engaging in a practice-based inquiry facilitated a reconceptualization of their practice and widened their occupational lens, thus strengthening their identity as occupational therapists. Given the barriers to demonstrating occupational therapy’s unique contribution to mental health practice, this research provides a valuable tool for practitioners.What This Article Adds: Occupational therapy practitioners who engage in context-specific, action-oriented research experience a transformative process that empowers them to address barriers often encountered in mental health practice and enact occupation-centered and justice-focused practice. PubDate: Fri, 27 Jan 2023 00:00:00 GMT DOI: 10.5014/ajot.2023.050046 Issue No:Vol. 77, No. 1 (2023)
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First page: 7701205070 Abstract: AbstractImportance: Few tools are available for assessing the activity performance of people with low vision. Additional practical instruments are required for occupational therapy evaluation.Objective: To evaluate the validity and reliability of the Turkish version of the Revised Low Vision Independence Measure (LVIM–R).Design: We analyzed Turkish LVIM–R items using confirmatory factor analysis with parceling. Test–retest reliability was measured using the intraclass correlation coefficient (ICC). The study was conducted between April 2020 and July 2021.Setting: Ophthalmology clinic.Participants: The study included 89 people with low vision who applied to an ophthalmology training and research clinic. Participants were age ≥18 yr, had visual acuity of 0.5 to 1.3 logarithms of the minimum angle of resolution, and consented to participate.Intervention: Not applicable.Outcomes and Measures: Turkish version of the LVIM–R, a self-report measure of activity performance for people with low vision.Results: In the principal-components analysis, the highest eigenvalue was Armor’s θ = .966. ICCs were .995 for Visual Field or Scotoma, .997 for Visual Acuity, and .997 for Total score. Other results included χ2 = 9.566 (p = .297), comparative fit index = .998, Tucker–Lewis Index = .996, and root mean square error of approximation = .047. Goodness-of-fit indices support the structural validity of the two-factor model.Conclusion: The Turkish version of the LVIM–R is a valid and reliable assessment tool for occupational therapy practice in low vision rehabilitation.What This Article Adds: The Turkish LVIM–R is a valid and reliable assessment for use in low vision rehabilitation. PubDate: Fri, 27 Jan 2023 00:00:00 GMT DOI: 10.5014/ajot.2023.050055 Issue No:Vol. 77, No. 1 (2023)
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First page: 7701205090 Abstract: AbstractImportance: In laboratory settings, dual-tasking is a performance strategy affected by dominance and stroke. However, the volitional use of dual-tasking has not been examined during naturalistic performance of activities of daily living (ADLs).Objective: To examine dual-tasking in the context of ADLs and identify whether dominance and stroke influence its use.Design: Cross-sectional, observational.Setting: Academic medical center.Participants: Forty-three participants with chronic stroke and upper extremity (UE) motor impairment and 19 control participants without stroke.Outcomes and Measures: We identified dual-tasking as the performance of dual-object primitives (DOPs), a functional strategy to manage two objects simultaneously. We videotaped participants performing feeding and toothbrushing tasks and identified the initiation and frequency of DOPs. We assessed whether these outcomes were influenced by UE dominance or paresis and whether among participants with stroke these outcomes were influenced by motor impairment (using the Fugl-Meyer Assessment) or cognitive impairment (using the Montreal Cognitive Assessment).Results: DOP initiation was reduced on the nondominant side of control UEs and in the paretic UE of participants with stroke. After DOPs were initiated, however, their frequency was not significantly related to dominance or paresis. Among participants with stroke, DOP initiation but not DOP frequency was influenced by motor impairment, and neither were influenced by cognitive impairment.Conclusions and Relevance: The initiation of dual-tasking is curtailed in the nondominant and paretic UEs, extending previous laboratory-based findings to a more naturalistic setting. These results may reflect a demand on neural resources that is exceeded when these limbs are used.What This Article Adds: DOPs, a functional strategy to simultaneously engage two objects during ADLs, could serve as a behavioral marker of dual-tasking in real-world activities, supporting their investigation more broadly. Practicing DOPs in rehabilitation could also train the integration of dual-tasking strategies in activity execution. PubDate: Tue, 31 Jan 2023 00:00:00 GMT DOI: 10.5014/ajot.2023.050063 Issue No:Vol. 77, No. 1 (2023)
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First page: 7701205110 Abstract: AbstractImportance: Internationally, it is suggested that school-based occupational therapy (SBOT) has an important role in supporting inclusion in educational settings. In SBOT, multitiered service delivery models are identified as a way forward to maximize school inclusion. Therefore, identifying evidence for the implementation of tiered interventions in SBOT is vital.Objective: To identify and map evidence in the occupational therapy literature relating to SBOT interventions delivered in elementary schools for all children, for those at risk, and for those with identified diagnoses.Data Sources: Peer-reviewed literature published in 14 occupational therapy journals between 1990 and 2020, indexed in the EBSCOhost database.Study Selection and Data Collection: Included studies were those within the scope of SBOT that reported on school occupations and focused on elementary school–age children (excluding kindergarteners or preschoolers).Findings: Forty studies met the criteria. Individual-tier intervention studies (n = 22) primarily reported direct interventions with children at risk or with identified diagnoses (Tier 2 or Tier 3), focusing mostly on remedial approaches. None adopted a whole-school approach. Despite handwriting and self-regulation being dominant areas of concern, these studies were not explicitly related to inclusion outcomes. Evidence for implementing multitiered models primarily used indirect, collaborative consultation, embedded in the school context (n = 18). These studies identified positive school staff and child outcomes when collaboration was timely, consistent, and authentic.Conclusions and Relevance: More rigorous individual-tier intervention studies are required to inform the design and implementation of multitiered interventions in SBOT and to support participation and inclusion in schools.What This Article Adds: This scoping review provides evidence to support occupational therapists’ professional reasoning in developing evidence-based, contextual, educationally relevant multitiered models of intervention in SBOT. PubDate: Fri, 27 Jan 2023 00:00:00 GMT DOI: 10.5014/ajot.2023.050027 Issue No:Vol. 77, No. 1 (2023)
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First page: 7701205140 Abstract: AbstractImportance: Stroke survivors report feeling unprepared to manage challenges that arise during the transition from hospital to home. Cultivating problem-solving skills before discharge may better prepare patients for the transition home.Objective: To determine the feasibility of a protocol to deliver Problem-Solving Training (PST) to stroke survivors during inpatient rehabilitation to increase goal achievement.Design: Single-group feasibility study.Setting: Academic and county hospital inpatient rehabilitation units.Participants: Adult patients with stroke and planned discharge home.Intervention: Up to six PST sessions over 2 to 3 wk followed by 3 mo of mobile health boosters.Results: Of 17 eligible participants, 15 consented and 11 completed three or more PST sessions. Six participants used electronic boosters, achieving at least one goal postdischarge. Participants reported high satisfaction with PST (Client Satisfaction Questionnaire–8 M score = 29.3, SD = 4.4; range = 8–32), moderate depression at baseline (eight-item Patient Health Questionnaire [PHQ–8] score, M = 11.0, SD = 6.1; range = 0–27), mild depression at 3 mo postdischarge (PHQ–8 score, M = 8.3, SD = 5.5), moderately high self-efficacy at baseline (General Self-Efficacy Scale [GSE] score, M = 31.1, SD = 7.3; range = 10–40), and a self-efficacy increase at 3 mo postdischarge (GSE score, M = 34.1, SD = 4.2).Conclusions and Relevance: PST among patients with stroke during inpatient rehabilitation was feasible, and participants demonstrated improvements in clinical outcomes and goal attainment. Barriers to participation and adherence should be addressed in future studies.What This Article Adds: Teaching patients problem-solving skills early after a stroke using a metacognitive strategy is feasible and may decrease depression and increase self-efficacy while fostering independent goal setting and problem solving. PubDate: Fri, 27 Jan 2023 00:00:00 GMT DOI: 10.5014/ajot.2023.050083 Issue No:Vol. 77, No. 1 (2023)
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First page: 7701205170 Abstract: AbstractImportance: Handwriting legibility is the main criterion for determining whether a child has handwriting difficulties. A comprehensive assessment of handwriting legibility with sound psychometrics is essential to timely identification of handwriting difficulties and outcome measurement after handwriting interventions.Objective: To evaluate the psychometrics of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) and to investigate Chinese handwriting legibility in school-age children using the CAM-CHL.Design: Cross-sectional, repeated observation, test–retest.Setting: Elementary schools in Taiwan.Participants: We recruited 25 lower-grade children for the examination of test–retest reliability, 75 children from all grade levels, and 10 senior schoolteachers for the examination of the CAM-CHL’s convergent validity and the investigation of handwriting legibility.Outcomes and Measures: Children were asked to copy a set of Chinese characters as legibly as possible. We used the CAM-CHL to assess handwriting legibility in four domains: Size, Orientation, Position, and Deformation. The schoolteachers were asked to subjectively assess the handwriting legibility using a 3-point Likert-type scale.Results: The CAM-CHL demonstrated good to excellent test–retest reliability and acceptable random measurement error in all legibility domains. The CAM-CHL had fair to moderate convergent validity with schoolteachers’ perceptions. Additionally, upper-grade children had better handwriting legibility in the Size and Position domains than lower-grade children.Conclusions and Relevance: The CAM-CHL, a comprehensive and objective method of assessing Chinese handwriting legibility, has sound reliability and acceptable validity, suggesting its potential as an outcome measure for school-age children.What This Article Adds: The CAM-CHL can be used in comprehensive evaluations of Chinese handwriting legibility in school-age children. The CAM-CHL has acceptable psychometrics for use as an outcome measure. PubDate: Thu, 02 Feb 2023 00:00:00 GMT DOI: 10.5014/ajot.2023.050075 Issue No:Vol. 77, No. 1 (2023)
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First page: 7701205020 Abstract: Importance: A simple measure that can be administered remotely by means of videoconferencing is needed for telerehabilitation.Objective: To develop a valid and reliable measure, the Arm Capacity and Movement Test (ArmCAM), that can be administered remotely by means of videoconferencing to evaluate upper extremity motor function poststroke.Design: Cross-sectional.Setting: Participants’ homes.Participants: A sample of people with stroke (N = 31).Outcomes and Measures: Test–retest and interrater reliabilities were assessed through intraclass correlation coefficients (ICCs), Cohen’s κ, standard error of measurement (SEM), and minimal detectable change (MDC). Interrater reliability validity was examined with Pearson and Spearman rank correlation coefficients.Results: The ArmCAM (range = 0–30) consists of 10 items and takes 15 min to administer with no special equipment except for a computer and internet access. The ICCs for test–retest reliability and interrater reliability were .997 and .993, respectively. The SEM and MDC95 were 0.74 and 2.05 points, respectively. Individual items’ test–retest reliability and interrater levels of agreement ranged from .811 to .957 and from .475 to .842, respectively, as measured with Cohen’s κ. Correlations between the ArmCAM and the Rating of Everyday Arm-use in the Community and Home scale; the Stroke Impact Scale, hand function domain; the Fugl-Meyer Assessment for upper extremity; and the Action Research Arm Test were good to excellent.Conclusions and Relevance: The ArmCAM has good reliability and validity. It is an easy-to-use assessment designed to be administered remotely by means of videoconferencing.What This Article Adds: The ArmCAM is a psychometrically sound instrument that can be easily administered remotely by means of videoconferencing to evaluate upper extremity motor function after stroke. PubDate: Wed, 26 Jan 2022 00:00:00 GMT DOI: 10.5014/ajot.2023.050020 Issue No:Vol. 77, No. 1 (2022)
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