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First page: 7805205010 Abstract: AbstractImportance: Visual–motor integration (VMI) is typically examined in children to promote handwriting, but it may also be relevant for adults’ capacity for technology use.Objective: To examine the reliability and validity of speed of completion of the box clicking test, a web-based test of VMI.Design: Participants in the Understanding America Study completed online surveys on a regular basis, including a very brief (less than 30 s) self-administered box clicking test. For validity testing, we examined whether box clicking speed was associated with constructs relevant to visual–perceptual skills and motor coordination, the skills underlying VMI. Test–retest reliability was examined by computation of intraclass correlation coefficients.Participants: A total of 11,114 adults.Measures: Measures included the completion time for the box clicking task and measures relevant to visual perception (e.g., perceptual speed) and motor coordination (e.g., self-reported functional limitation).Results: Results suggested that the box clicking test was a VMI task. Slower test performance was associated with lower visual–perceptual speed and a greater likelihood of reporting difficulties with dressing, a motor coordination relevant task. Box clicking tests taken within at least 2 yr of one another had moderate test–retest stability, but future studies are needed to examine test–retest reliabilities over brief (e.g., 2-wk) time intervals.Conclusions and Relevance: The box clicking test may serve both as a tool for research and to clinically observe whether clients have VMI difficulties that interfere with computer, smartphone, or tablet use.Plain-Language Summary: Use of devices such as smartphones and computers is increasingly becoming integral for daily functioning. Visual–motor integration (VMI) has often been addressed by occupational therapists to support handwriting of children, but it may also be important for technology use by adults. Prior literature supports the relevance of VMI to technology use, and adults with various chronic conditions have been found to have decrements in VMI. We tested the psychometric properties of a brief box clicking test of VMI that could be used to examine VMI underlying technology use among adults. Overall, results suggested that the box clicking test was a VMI task. Just as speed of gait has been used as an index of functional mobility, speed on the box clicking task seemed serviceable as an index of VMI ability. The box clicking test may also be used for clinical observation of whether VMI interferes with technology use. PubDate: Fri, 26 Jul 2024 00:00:00 GMT DOI: 10.5014/ajot.2024.050680 Issue No:Vol. 78, No. 5 (2024)
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First page: 7805205070 Abstract: Importance: Caregiver-performed home therapy programs are essential to occupational therapy intervention for infants and children with neuromotor and neuromuscular diagnoses. Factors that facilitate or are barriers to caregiver adherence when making home therapy recommendations should be considered.Objective: To identify facilitators of and barriers to caregiver adherence to home therapy recommendations for children with neuromotor and neuromuscular disorders.Method: The review followed the five-step methodological framework developed by Arksey and O’Malley (2005) and was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.Data Sources: Searches with no language or date range limits were performed in MEDLINE, CINAHL Plus with Full Text, PsycINFO, and SocINDEX on the EBSCO platform, and Scopus on the Elsevier platform from database inception through January 24, 2023.Study Selection and Data Collection: Study inclusion criteria included caregiver adherence to home therapy recommendations for children with neuromotor and neuromuscular diagnoses. Eight hundred seventy-five articles underwent title and abstract screening; 64 articles met the criteria for full review.Findings: Twelve articles met the inclusion criteria. Four used qualitative measures, 7 used quantitative measures, and 1 used mixed methods. Qualitative thematic analysis revealed four facilitators: routine, efficacy of caregiver education, positive relationship with therapist, and perceived benefit of treatment. The analysis revealed three barriers: lack of time, lack of confidence, and caregiver stress.Conclusions and Relevance: The facilitators and barriers identified are central to best-practice occupational therapy. Therapists can use expertise in analyzing routines and context to maximize the fit between family needs and home therapy recommendations.Plain-Language Summary: Home therapy for children with a neuromotor and neuromuscular diagnosis is common and uses some form of caregiver-performed movement activities or techniques. To support caregivers, occupational therapists need to understand what factors facilitate or serve as barriers to following home therapy recommendations. The review found three barriers: lack of time, lack of confidence, and caregiver stress. The review provides strategies to support home therapy based on core principles of occupational therapy practice. It also identifies the need for more research to support home therapy recommendations that fit within the child’s and family’s routine, that can be taught in a way that meets the child’s and family’s learning needs, that facilitate self-efficacy and confidence, and that reflect the values and motivators of all participants. PubDate: Wed, 31 Jul 2024 00:00:00 GMT DOI: 10.5014/ajot.2024.050567 Issue No:Vol. 78, No. 5 (2024)
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First page: 7805205080 Abstract: AbstractImportance: Self-feeding independence is often the first goal in acute stroke rehabilitation. Attention deficits appear frequently after stroke, but neuropsychological tests may be difficult to perform in the acute phase, and the effect on self-feeding activities may be difficult to detect. Therefore, we aimed to clarify behavioral problems with self-feeding using the Moss Attention Rating Scale (MARS), a behavioral observational rating scale of attentional function, for a better understanding of the effects of self-feeding.Objective: To identify behavioral problems caused by attention deficits among patients with acute stroke who need assistance in self-feeding, using the MARS.Design: Cross-sectional single-center study.Setting: St. Marianna University Yokohama Seibu Hospital, Kanagawa, Japan.Participants: A total of 96 patients (42 women and 54 men) were admitted to the hospital for stroke treatment. Patients’ median age was 75.0 yr. The date of evaluation was a median of 3.0 days from admission.Outcome and Measures: The primary outcome was the FIM® eating subscore. The secondary outcome was the MARS score.Results: Significant differences were noted in the total raw MARS, logit, and three-factor scores for self-feeding independence (p < .01). The effect size of the consistent or sustained factor on independence was large (r = .83).Conclusions and Relevance: Behavioral problems related to self-feeding dependence include the inability for sustained attention. Our results suggest that sustained concentration during self-feeding is necessary for eating independence. Rehabilitation focused on sustained attention is important for independent self-feeding.Plain-Language Summary: A patient’s self-feeding independence is often the first goal in acute stroke rehabilitation. Patients frequently experience attention deficits after a stroke, but neuropsychological tests may be difficult to perform in the acute phase of rehabilitation, and the effect of attention deficits on self-feeding may be difficult to identify. To have a better understanding of the effects on self-feeding, this study aimed to identify behavioral problems using the Moss Attention Rating Scale (MARS). The study found that the MARS can be used to identify behavioral problems related to self-feeding independence, which can help occupational therapists to develop rehabilitation programs for their clients who have experienced a stroke. PubDate: Fri, 26 Jul 2024 00:00:00 GMT DOI: 10.5014/ajot.2024.050644 Issue No:Vol. 78, No. 5 (2024)
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First page: 7805205090 Abstract: AbstractImportance: Work-related musculoskeletal disorders (WMSDs) among surgeons are markedly increasing. Several proposed interventions to reduce WMSDs among surgeons have been studied, but few follow an occupational therapy–oriented approach addressing biomechanical, psychophysical, and psychosocial risk factors.Objective: To design, implement, and assess the potential of the Comprehensive Operating Room Ergonomics (CORE) program for surgeons, a holistic evidence-based ergonomics and wellness intervention grounded in occupational therapy principles.Design: Mixed-methods pilot study with the quantitative strand embedded in the qualitative strand.Setting: University-affiliated hospital.Participants: Six laparoscopic surgeons.Outcomes and Measures: CORE program outcomes were assessed using qualitative and quantitative data to indicate changes in posture, physical discomfort, sense of wellness, and operating room (OR) ergonomic performance. The Rapid Upper Limb Assessment (RULA) was used to quantify surgeons’ WMSD risk level before and after intervention.Results: There were 12 baseline observations (two for each participant), and two or three post-CORE implementation observations. A statistically significant difference, F(1, 6) = 8.57, p = .03, was found between pre– and post–occupational therapy intervention RULA scores. Thematic analysis of surgeon feedback, which was overwhelmingly positive, identified five themes: postural alignment, areas of commonly reported physical pain or discomfort, setup of the OR environment, surgical ergonomics training, and ergonomics in everyday life.Conclusions and Relevance: The CORE program effectively decreased ergonomic risk factors to optimize surgeons’ occupational performance in the OR. This study demonstrates a potential solution to how occupational therapists can holistically support surgeons and health care providers who are at risk for WMSDs.Plain-Language Summary: By 2025, a surgeon shortage is expected, partly because of the increase in surgeons’ work-related musculoskeletal disorders, which affect their health and job continuity. This pilot study shows that the Comprehensive Operating Room Ergonomics program effectively addresses these problems. The study also serves as a framework for occupational therapy professionals to work with health care providers on ergonomics, benefiting population health. Results suggest that this approach could enhance surgeons’ work conditions, supporting the American Occupational Therapy Association’s Vision 2025 to improve health and quality of life. PubDate: Wed, 31 Jul 2024 00:00:00 GMT DOI: 10.5014/ajot.2024.050395 Issue No:Vol. 78, No. 5 (2024)
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First page: 7805205120 Abstract: AbstractImportance: Typical whole day workload is a metric with potential relevance to the occupational balance and well-being of individuals with chronic conditions.Objective: To examine the reliability and validity of using multiple daily NASA Task Load Index measures (whole day TLX) as an indicator of typical whole day workload experienced by adults with Type 1 diabetes (T1D).Design: Participants with T1D completed cross-sectional measures and 2 wk of ecological momentary assessments (EMA) and daily diaries. Reliability was assessed across subgroups (e.g., workers vs. nonworkers); validity was evaluated with multilevel confirmatory factor analysis and with tests of convergent and divergent validity with patient-reported outcomes and blood glucose measures.Setting: Three outpatient endocrinology clinics in the United States.Participants: Data from 164 U.S. adults with T1D (42% Latino, 30% White).Outcomes and Measures: Measures used included the whole day TLX (assessed via 2 wk of daily diaries), time in target blood glucose range (assessed with a continuous glucose monitor), illness intrusiveness (measured cross-sectionally), and stress (measured cross-sectionally and with EMA).Results: Number of days required for at least 0.70 reliability of the average whole day TLX ranged between 2 and 6 days depending on the subgroup. Results supported convergent and divergent validity of the average of the whole day TLX, including associations with average stress (r = .63, p < .001) and time in target blood glucose range (r = –.25, p = .002).Conclusions and Relevance: The whole day TLX was a reliable and valid indicator of typical whole day workload.Plain-Language Summary: The health management responsibilities for Type 1 diabetes can be extremely burdensome. When these responsibilities are experienced, in addition to duties such as work and caregiving, the totality of demands experienced (i.e., whole day workload) can create further issues, such as unhealthy physiological changes and interference with self-care. We tested the psychometric properties of a measurement tool that assesses the typical level of workload people experience. This measure, referred to as the NASA Task Load Index (whole day TLX), was found to be a reliable and valid indicator of typical whole day workload. Occupational therapists may use the whole day TLX to track progress in interventions focused on reducing clients’ whole day workload exposure to promote their health and well-being. Occupational therapists’ expertise in areas such as activity analysis, task adaptation, and energy conservation makes them especially well-suited to intervene on whole day workload. PubDate: Fri, 19 Jul 2024 00:00:00 GMT DOI: 10.5014/ajot.2024.050527 Issue No:Vol. 78, No. 5 (2024)
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First page: 7805205140 Abstract: AbstractImportance: Occupational therapy practitioners need modern tools for the assessment of maximal grip strength in clinical and remote settings.Objective: To establish the (1) interrater reliability and (2) precision of the GripAble among three raters with different expertise in occupational therapy when testing healthy participants, and to (3) evaluate the relative reliabilities of different approaches to estimating grip strength (i.e., one trial, mean of two trials, and the mean of three trials).Design: Measurement study.Setting: Minnesota Translational Musculoskeletal and Occupational Performance Research Lab, University of Minnesota, Minneapolis.Participants: Thirty volunteers, age ≥18 yr, without any hand problems.Outcomes and Measures: Using GripAble, three occupational therapy raters with varied experience measured the maximal grip strength of the dominant and nondominant hands of all participants. Using the mean of three trials when testing grip strength with GripAble adds precision.Results: GripAble has excellent interrater reliability (i.e., intraclass correlation coefficient > .75) and acceptable precision (minimal detectable change < 15%) among healthy adults.Conclusions and Relevance: GripAble allows occupational therapy practitioners with different experiences to assess grip strength in healthy hands quickly, precisely, and with excellent reliability. Additional research is needed on its psychometrics in clinical populations and capacities in remote monitoring and exergaming.Plain-Language Summary: The results of this study show that grip strength, an important biomarker and commonly assessed construct in occupational therapy, can be evaluated reliably, precisely, and rapidly with GripAble. The use of GripAble by occupational therapy practitioners in clinical settings may help to build an infrastructure for remote measurements and exergaming interventions in the future. PubDate: Mon, 29 Jul 2024 00:00:00 GMT DOI: 10.5014/ajot.2024.050689 Issue No:Vol. 78, No. 5 (2024)
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First page: 7805205170 Abstract: AbstractImportance: Large educational transitions occur when students enter and exit school or move between grades or divisions within the kindergarten to Grade 12 (K–12) school system. For students with disabilities, the quality of large educational transitions affects academic and postschool outcomes, which is germane to school-based occupational therapists.Objective: To explore the school-based occupational therapy literature to describe the roles of occupational therapists in supporting large educational transitions and to identify relevant terminology.Data Sources: We searched six databases (CINAHL, EMCare, Embase, ERIC, MEDLINE, and PsycINFO) for peer-reviewed publications in English with no date limitations.Study Selection and Data Collection: We included articles focused on children and youth with disabilities and school-based occupational therapy services supporting large transitions within K to 12 education. Using directed content analysis, we reported on publication characteristics, occupational therapy roles, and terminology.Findings: We included 46 publications spanning 37 yr that addressed transitions into school (n = 3), within K to 12 grades or divisions (n = 10), or to exit secondary education (n = 33). Occupational therapists assumed many roles in supporting large transitions, some much more frequently than others; 125 transition terms were used across included articles with few terms explicitly defined.Conclusions and Relevance: School-based occupational therapists’ involvement in educational transitions is extensive, with potential for expansion. Consistency in terminology would support future research and practice.Plain-Language Summary: A large educational transition occurs when students move between a school, grade, or division as part of their K to 12 education. For students with disabilities, the quality of a large educational transition affects their academic and postschool outcomes. This review provides an understanding of how school-based occupational therapists support educational transitions for youth with disabilities. The review found that occupational therapists took on many roles, with the potential for expanding their roles. The review also identified 125 transition terms that were used across the literature review and found that few terms were explicitly defined. Consistency in terminology would support future research and expanded occupational therapy practice in this area. PubDate: Thu, 01 Aug 2024 00:00:00 GMT DOI: 10.5014/ajot.2024.050634 Issue No:Vol. 78, No. 5 (2024)
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First page: 7805205190 Abstract: AbstractLong COVID—persistent health complications after recovery from coronavirus disease 2019 infection—is associated with activity limitations in nearly 48 million U.S. adults, affecting work, leisure, family, and community functioning. Occupational therapists are experts in customizing interventions to maximize performance of daily routines, and often treat individuals who experience similar functional impacts to those observed in long COVID. The large number of people experiencing new disability, as well as a lack of medical treatment options, make occupational therapy a crucial component of long-COVID research and multidisciplinary management. In this column, we discuss actionable steps occupational therapists can take to place them at the forefront of maximizing functional and quality-of-life outcomes for people with long COVID. PubDate: Thu, 01 Aug 2024 00:00:00 GMT DOI: 10.5014/ajot.2024.050707 Issue No:Vol. 78, No. 5 (2024)
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First page: 7805205210 Abstract: AbstractImportance: Occupational therapy is one of the most used interventions for children on the autism spectrum. There is a critical need to develop an operationalized list of key treatment components of usual-care occupational therapy practice for children on the autism spectrum.Objective: To identify and develop consensus on definitions and examples of key treatment components of usual-care occupational therapy for children on the autism spectrum, ages 6 to 13 yr.Design: We conducted a Delphi study to obtain feedback from a panel of experts.Setting: Electronic survey.Participants: 17 occupational therapy panelists with expertise in autism intervention.Outcomes and Measures: Panelists rated the definition and example of each treatment component and provided feedback through multiple rounds of survey.Results: On the basis of the panelists’ feedback on Delphi Round 1, the criteria rating form was revised to include four questions for the definition and example of each treatment component. Through four Delphi rounds of consensus building, we developed an operationalized list of 20 treatment components with definitions and examples that incorporated elements of usual-care occupational therapy intervention for children on the autism spectrum.Conclusions and Relevance: This operationalized list of treatment components serves as a foundational framework to improve education, practice, and research of occupational therapy intervention for children on the autism spectrum.Plain-Language Summary: This study identified and developed consensus on definitions and examples of key treatment components used in usual-care outpatient occupational therapy for children on the autism spectrum. Through four rounds of consensus building with 17 occupational therapy experts in autism, we identified 20 key treatment components central to occupational therapy practice. Our results have the potential to serve as a framework to improve education, practice, and clinical research in autism. PubDate: Fri, 19 Jul 2024 00:00:00 GMT DOI: 10.5014/ajot.2024.050734 Issue No:Vol. 78, No. 5 (2024)
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First page: 7805347010 Abstract: AbstractIn recent years, there has been increased interest in completing occupational therapy doctoral capstones with people experiencing homelessness. Given the complexity of practice with this population and its history of discrimination and marginalization, we argue for the development of guidelines for completing capstones in unhoused settings. In this column, we present background and contextual information, justification for the need for guidelines, and preliminary recommendations for consideration by students and faculty. Our aim is to invite reflection within the profession and among academic institutions and to promote dialogue with community agencies that serve this population to ensure that capstones are developed ethically, sustainably, and without unintentionally perpetuating harm. PubDate: Fri, 02 Aug 2024 00:00:00 GMT DOI: 10.5014/ajot.2024.050800 Issue No:Vol. 78, No. 5 (2024)
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