Importance: Insufficient voluntary forearm movements are associated with ineffective and inefficient functional performance among people poststroke. Although evidence supports the application of the occupational therapy task-oriented (OTTO) approach for this population, the training protocol does not explicitly address the role of forearm rotation movements. In addition, a need exists for theoretical support for orthotic interventions for people poststroke. Objective: To examine the efficacy of (1) a forearm rotation orthosis, (2) the OTTO approach, and (3) the combination of the two with people poststroke with a hemiparetic arm. Design: Stratified, randomized, two-group, single-blinded, repeated-measures design. Setting: Rehabilitation clinic. Participants: Participants (N = 14) with a diagnosis of stroke and at least 10° of voluntary shoulder and elbow movement. Intervention: Participants were stratified into three groups by motor function (mild, moderate, severe) and randomly assigned either to 6 wk of no treatment followed by 6 wk of OTTO or to 6 wk of orthotic intervention followed by 6 wk of orthosis plus OTTO. Outcomes and Measures: Primary outcome measures were the Canadian Occupational Performance Measure (COPM), Wolf Motor Function Test (WMFT), and Motor Activity Log (MAL), administered at baseline (Week 1), at the end of Phase 1 (Week 7), and at the end of Phase 2 (Week 15) by blinded evaluators. Results: Both groups showed clinically important improvements on the COPM. No significant differences were found on the WMFT or MAL. Conclusions and Relevance: The OTTO intervention provides clinically important benefits in self-perceived functional performance to people poststroke. What This Article Adds: The OTTO approach is an occupation-focused intervention that aims at functional performance and emphasizes clients' active engagement throughout the process. The findings suggest that the protocol of the OTTO intervention and its efficacy are appropriate for clinical practice.

Appraising the best available evidence substantiating and informing occupational therapy practice is a commonly expressed obligation for the profession ( American Occupational Therapy Association [AOTA], 2007 ). In this article we argue for the full inclusion of qualitative research, on parity with quantitative research, as a source for evidence of relevant and effective occupational therapy practice, review the limitations of quantitative research, and outline the distinctive contributions of qualitative studies to the practice of occupational therapy for people with autism spectrum disorder (ASD). In addition, we describe the role of qualitative studies in the fulfillment of the Centennial Vision ( AOTA, 2007 ) and recommend three action steps for the profession.

OBJECTIVE. The purpose of this study was to examine how U.S. occupational therapists access and use clinically relevant research results. METHOD. During the spring of 2000, 209 clinically practicing occupational therapists who were members of the American Occupational Therapy Association responded to a survey (58% response rate). The distribution of opinions and self-reported behavior was portrayed by descriptive statistics, and chi-square cross-tabulations and Pearson correlation coefficients were calculated between demographic and evidence-based practice variables. RESULTS. Respondents occasionally accessed research information through a variety of resource media. The majority (57%) implemented between one and five new, research-based treatment plans in the past year. Compared with respondents with less experience, a greater proportion of respondents with 15 or more years of clinical experience did not believe that research conclusions usually translated into treatment plans for individual clients (X² = 20.620, p < .01). Almost three fifths (59%) of respondents reported that time was provided on the job to attend continuing education; however, 45% strongly disagreed that time was available at work to access research information. Other reported barriers to research utilization included lack of time on the job, high continuing education costs, weak research analysis skills, and placing higher value on clinical experience than on research. CONCLUSIONS. These findings suggest that therapists are currently engaging in a modest amount of evidence-based practice. Removing the barriers identified in this study may increase research utilization among clinicians.

Objectives. A retrospective study was conducted to determine to what extent persons with postacute cerebrovascular accident (CVA) made progress toward rehabilitation goals during occupational therapy treatment and whether age and time since CVA onset affected the rate of goal achievement. Method. Data were collected from the admission and discharge records of persons with CVA who had received occupational therapy at a university clinic, who were at least 8 months post CVA, and who had not received therapy in the community for at least 6 months. The treatment was provided by occupational therapy students under supervision and had a mean length of 12 1-hr sessions over one semester. A sample size of 85 was obtained from 13 years of clinic records. Results. All patients in the sample except one made progress toward at least one of their selected rehabilitation goals. The group mean score for goal progress indicated that as a whole, the patients made significant gains. In addition, independent t tests showed no significant differences in mean scores between younger and older patients, between longer and shorter times since onset, between men and women, or between right and left CVA. There was no significant linear association between mean score and the number of treatments received. Conclusion. Patients with CVA showed progress toward rehabilitation goals during postacute treatment. Patients with recent CVA onset or of younger age did not achieve goals at a significantly higher rate than those with less recent onset or of greater age.

Objective. This study was conducted to identify factors that were significant in predicting occupational therapy treatment choices and discharge outcomes after inpatient rehabilitation for 112 patients who had experienced a cerebrovascular accident. Method. A retrospective descriptive study was conducted. Results. According to discriminant function analysis, the cerebrovascular accident disability Score (i.e., level of functional disability) during the initial evaluation period was the predictor of discharge outcomes with the most clinical significance. A greater proportion of occupational therapy assessment units was the most influential occupational therapy factor associated with a positive discharge outcome. In one inpatient rehabilitation setting, a greater proportion of occupational therapy intervention for all study subjects was directed at the level of impairment compared to the level of disability. Conclusion. Shorter inpatient stays, as well as shifts to outpatient rehabilitation, may require occupational therapists to examine whether intervention at the level of impairment or disability yields the best functional outcomes for patients who have sustained a cerebrovascular accident.

Objectives. A retrospective study was conducted to investigate differences in the functional outcome between patients with left cerebrovascular accident (left CVA) and right cerebrovascular accident (right CVA) in wheelchair transfer performance. It was hypothesized that the level of improvement in left CVA and right CVA groups of patients would not be the same, due to the different constellation of neurological impairments. Method. Data were obtained from the admission and discharge scores on the Functional Independence Measure of 100 male patients, 50 with left CVA and 50 with right CVA. Results. Both groups demonstrated a statistically significant improvement between admission and discharge for wheelchair to bed, wheelchair to toilet, and wheelchair to tub or shower transfer (p < .001). However, there were no statistically significant differences between the two groups at admission or discharge for any of the three transfer, even after statistical removal of the effects of age, number of days from onset at stroke to rehabilitation, and number of days in rehabilitation. Conclusion. The lack of difference between the groups at time of discharge may have obscured a difference in the rate of transfer learning during the course of rehabilitation.